Provider Demographics
NPI:1871798066
Name:PATEL, AMITA DINESHKUMAR (OD)
Entity type:Individual
Prefix:DR
First Name:AMITA
Middle Name:DINESHKUMAR
Last Name:PATEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 CORPORATE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-5113
Mailing Address - Country:US
Mailing Address - Phone:713-773-0803
Mailing Address - Fax:713-271-5422
Practice Address - Street 1:7001 CORPORATE DR STE 120
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-5113
Practice Address - Country:US
Practice Address - Phone:713-773-0803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6952TG152W00000X
NM579152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217693501Medicaid
TX1J9242OtherMEDICARE
TX217693502Medicaid
TX217693503Medicaid
TXTXB100553Medicare PIN
TX217693501Medicaid