Provider Demographics
NPI:1174575542
Name:PATEL, KRUTI (OD)
Entity type:Individual
Prefix:DR
First Name:KRUTI
Middle Name:
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 1:401 GATES PKWY # P106
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-3535
Mailing Address - Country:US
Mailing Address - Phone:469-325-4728
Mailing Address - Fax:844-440-1558
Practice Address - Street 1:401 GATES PKWY # P106
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-3535
Practice Address - Country:US
Practice Address - Phone:469-325-4728
Practice Address - Fax:844-440-1558
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8598TG152W00000X, 152W00000X
NJ27OA00599801152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJZ08154Medicare UPIN