Provider Demographics
NPI:1073322384
Name:TINA S. PATEL, O.D. , PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:TINA S. PATEL, O.D. , PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:SHANTUBHAI
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-722-7520
Mailing Address - Street 1:631 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2801
Mailing Address - Country:US
Mailing Address - Phone:213-680-0404
Mailing Address - Fax:213-680-2853
Practice Address - Street 1:631 N BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2801
Practice Address - Country:US
Practice Address - Phone:213-680-0404
Practice Address - Fax:213-680-2853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-01
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center