=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427459536
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCULOPLASTICS & OPHTHALMOLOGY AT LITTLETON, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2014
-----------------------------------------------------
Last Update Date | 02/09/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1869 W LITTLETON BLVD
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80120-2020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-848-2848
-----------------------------------------------------
Fax | 303-795-3023
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1869 W LITTLETON BLVD
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80120-2020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-848-2848
-----------------------------------------------------
Fax | 303-795-3023
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. NEHA PATEL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 312-493-5855
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS0132X
-----------------------------------------------------
Taxonomy Name | Ophthalmologic Surgery Clinic/Center
-----------------------------------------------------
License Number | 49006
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------