Healthcare Provider Details

I. General information

NPI: 1730670829
Provider Name (Legal Business Name): HIREN ASHOK PATEL OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 MALLARD LN
TAYLOR TX
76574-1214
US

IV. Provider business mailing address

2120 ROUND ROCK AVE STE 100
ROUND ROCK TX
78681-4010
US

V. Phone/Fax

Practice location:
  • Phone: 512-352-7664
  • Fax: 512-365-5237
Mailing address:
  • Phone: 512-244-1991
  • Fax: 512-244-1786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4428ATI
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10625TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: