Basic Information
| Provider Information | |||||||||
| NPI: | 1619173986 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4401 MARTIN LUTHER KING BLVD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772042020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137432020 | ||||||||
| FaxNumber: | 7137430763 | ||||||||
| Practice Location | |||||||||
| Address1: | 4401 MARTIN LUTHER KING BLVD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772042020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137432020 | ||||||||
| FaxNumber: | 7137430763 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2007 | ||||||||
| LastUpdateDate: | 05/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2068 | NC | N | Eye and Vision Services Providers | Optometrist | 152W00000X | OPC4372 | FL | N | Eye and Vision Services Providers | Optometrist | 152WC0802X | 8586T | TX | N | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management | 390200000X | NC | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 152W00000X | 8586 | TX | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 354254001 | 05 | TX | MEDICAID | 5910394 | 05 | NC | MEDICAID |