Individual provider Active NPI

Dixita S Patel, OD

  • Optometrist
  • Seattle, WA
National Provider Identifier
1053670737
Registry record updated Jan 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD.60291501 Issued in WA
Practice address
1000 Minor Ave Apt 1106
Seattle, WA 98104-1392
Phone
(765) 412-0336
NPI assigned
May 15, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 17, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Optometrist 152W00000X OD.60291501 WA Primary

Addresses

Primary practice location

1000 Minor Ave Apt 1106
Seattle, WA 98104-1392

Mailing address

14050 Juanita Dr NE Ste a
Kirkland, WA 98034-9708

Other names 1

  • Dixitaben Patel Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140318002110 WA Practitioner - Optometry 9739310681 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OD.60291501WAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Mayemura, Inc. Optometrist CurrentSince Sep 1, 2016 Accepting new patients
Mayemura, Inc. Optometrist CurrentSince Sep 1, 2016 Accepting new patients
Darran Kim O.D. PLLC Optometrist CurrentSince Aug 6, 2023 Accepting new patients

Locations

10101 19th Ave SE
#B
Everett, WA 98208
Phone (425) 338-5400

14050 Juanita Dr NE
Ste A
Kirkland, WA 98034
Phone (425) 242-8974

23009 56th Ave W
#A
Mountlake Terrace, WA 98043
Phone (253) 517-3334

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1337040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673913600000",
    "number": "1053670737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14050 JUANITA DR NE STE A",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980349708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 MINOR AVE APT 1106",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981041392",
            "telephone_number": "765-412-0336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "DIXITA",
        "middle_name": "S",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-15",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD.60291501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIXITABEN",
            "last_name": "PATEL",
            "credential": "OD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.