MEDICARE: DR. MITUL MEHTA MD

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	207W00000X	Ophthalmology Physician	A130598	CA
2	207WX0107X	Retina Specialist (Ophthalmology) Physician	A130598	CA

General Provider Information

NPI Number	:	1730341181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITUL MEHTA MD

Provider Business Mailing Address
First Line	:	200 S MANCHESTER AVE STE 300
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-3219
Country	:	US
Telephone Number	:	714-456-2986
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 HEALTH SCIENCES RD
Second Line	:	DEPT OF OPHTHALMOLOGY
City	:	IRVINE
State	:	CA
Zip	:	92697-4375
Country	:	US
Telephone Number	:	949-824-2020
Fax Number	:	949-824-4015

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

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	01/23/2025

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