MEDICARE: NIKITA 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	6571	OH

General Provider Information

NPI Number	:	1952830861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKITA PATEL OD

Provider Business Mailing Address
First Line	:	PO BOX 207170
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75320-7170
Country	:	US
Telephone Number	:	636-200-4393
Fax Number	:	636-527-0766

Provider Business Practice Location Address
First Line	:	3510 MANCHESTER RD
Second Line	:
City	:	COVENTRY TOWNSHIP
State	:	OH
Zip	:	44319-1415
Country	:	US
Telephone Number	:	330-753-2100
Fax Number	:	330-633-7165

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

Provider Enumeration Date	:	06/06/2017
Last Update Date	:	07/28/2023

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Directions to “ NIKITA PATEL OD” Practice Location

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