Healthcare Provider Details

I. General information

NPI: 1871373498
Provider Name (Legal Business Name): JIL PRATIKBHAI PATEL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9725 DATAPOINT DR # 69
SAN ANTONIO TX
78229-2384
US

IV. Provider business mailing address

22727 WATER EDGE LN
KATY TX
77494-2307
US

V. Phone/Fax

Practice location:
  • Phone: 210-283-6832
  • Fax:
Mailing address:
  • Phone: 832-275-5586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number10933T
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number10933T
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10933T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: