MEDICARE: DR. PRITAL MEHTA PATEL OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2732	NC
2	152W00000X	Optometrist	OPT.006879	OH

General Provider Information

NPI Number	:	1033732649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRITAL MEHTA PATEL OD

Provider Business Mailing Address
First Line	:	15933 CLAYTON RD STE 210
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63011-2172
Country	:	US
Telephone Number	:	636-200-4393
Fax Number	:	636-527-0766

Provider Business Practice Location Address
First Line	:	1575 NC HIGHWAY 66 S
Second Line	:
City	:	KERNERSVILLE
State	:	NC
Zip	:	27284-3516
Country	:	US
Telephone Number	:	336-993-8514
Fax Number	:	336-993-6950

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2020
Last Update Date	:	12/04/2025

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