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General NPI Number Information
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NPI Number | 1508132986
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Entity Type | Organization
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Legal Business Name | LAKE NONA OPHTHALMOLOGY PL
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Dates
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Enumeration Date | 03/29/2012
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Last Update Date | 01/24/2024
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Provider Practice Location Address
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Address Line | 6718 LAKE NONA BLVD STE 140
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City | ORLANDO
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State | FL
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Zip | 32827-7984
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Country | US
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Telephone | 407-857-3937
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Fax | 407-392-0420
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Provider Business Mailing Address
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Address Line | 6718 LAKE NONA BLVD STE 140
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City | ORLANDO
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State | FL
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Zip | 32827-7984
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Country | US
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Telephone | 407-857-3937
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Fax | 407-319-0420
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. CHIRAG JITENDRA PATEL
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Credential | M.D.
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Telephone | 352-978-4896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME111106
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License Number State | FL
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