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General NPI Number Information
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NPI Number | 1740406057
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Entity Type | Organization
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Legal Business Name | CAPITAL OPTOMETRY GROUP, PA
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4970 W HIGHWAY 290 STE 410
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City | AUSTIN
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State | TX
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Zip | 78735-6724
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Country | US
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Telephone | 512-899-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 6004 HOOD HOLLOW
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City | AUSTIN
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State | TX
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Zip | 78731
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MANISH PATEL
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Credential | OD
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Telephone | 512-899-2020
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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 | 5814TG
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License Number State | TX
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