Healthcare Provider Details

I. General information

NPI: 1619432002
Provider Name (Legal Business Name): ASHISH PATEL OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2019
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4450 UNIVERSITY BLVD STE 140
ROUND ROCK TX
78665-2282
US

IV. Provider business mailing address

4450 UNIVERSITY BLVD STE 140
ROUND ROCK TX
78665-2282
US

V. Phone/Fax

Practice location:
  • Phone: 512-240-7766
  • Fax:
Mailing address:
  • Phone: 512-240-7766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9506TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: