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General NPI Number Information
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NPI Number | 1477853869
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Entity Type | Organization
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Legal Business Name | DR. MANISH C. PATEL AND ASSOCIATES PA
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Dates
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Enumeration Date | 11/01/2010
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Last Update Date | 01/23/2011
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Provider Practice Location Address
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Address Line | 10915 BAYMEADOWS RD SUITE 110
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City | JACKSONVILLE
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State | FL
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Zip | 32256-9130
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Country | US
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Telephone | 904-716-5026
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Fax | 904-223-0088
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Provider Business Mailing Address
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Address Line | 10915 BAYMEADOWS RD SUITE 110
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City | JACKSONVILLE
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State | FL
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Zip | 32256-9130
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Country | US
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Telephone | 904-716-5026
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Fax | 904-223-0088
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Authorized Official
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Title or Position | OD OWNER/PROVIDER
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Name | DR. MANISH C. PATEL
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Credential | OD
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Telephone | 904-716-5026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC3505
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License Number State | FL
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