Basic Information
| Provider Information | |||||||||
| NPI: | 1780626747 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | PARESH | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1007A SKYWAY DR | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281103042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042891547 | ||||||||
| FaxNumber: | 7042919441 | ||||||||
| Practice Location | |||||||||
| Address1: | 1007A SKYWAY DR | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281103042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042891547 | ||||||||
| FaxNumber: | 7042919441 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 07/11/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1739 | NC | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 89093MA | 05 | NC | MEDICAID | 093MA | 01 | NC | BCBSNC PIN | OTHER |