MEDICARE: DR. RONAK MEHTA O.D.

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	TA2156	MD

General Provider Information

NPI Number	:	1801022686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONAK MEHTA O.D.

Provider Business Mailing Address
First Line	:	8358 MONTGOMERY RUN RD
Second Line	:	UNIT H
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-7286
Country	:	US
Telephone Number	:	443-629-1192
Fax Number	:

Provider Business Practice Location Address
First Line	:	8358 MONTGOMERY RUN RD
Second Line	:	UNIT H
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-7286
Country	:	US
Telephone Number	:	443-629-1192
Fax Number	:

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

Provider Enumeration Date	:	06/07/2009
Last Update Date	:	09/02/2010

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