Individual provider Active NPI

Shetal Patel, OD

  • Optometrist
  • Orlando, FL
National Provider Identifier
1336792290
Registry record updated Jun 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC5717 Issued in FL
Practice address
1911 N Mills Ave
Orlando, FL 32803-1407
Phone
(407) 893-8200
Fax
(407) 893-8210
NPI assigned
Jul 19, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC5717 FL Primary

Addresses

Primary practice location

1911 N Mills Ave
Orlando, FL 32803-1407

Mailing address

1911 N Mills Ave
Orlando, FL 32803-1407
Phone (407) 893-8200

Other practice location 1

3140 Citrus Tower Blvd Bldg 11
Clermont, FL 34711-6888
Phone (352) 243-2121

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20191202000832 FL Practitioner - Optometry 1052744240 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Myeyedr Optometry of Florida, LLCGroup PAC ID 0143541037, 141 clinicians

Practice addresses (Care Compare)

1114 Gramercy LN
Tampa, FL 33607-4807
Phone (813) 807-7954

1480 Timberlane Rd
Tallahassee, FL 32312-1713
Phone (850) 893-4005

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPC5717FLMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Park Avenue Ophthalmics, PLLC Optometrist CurrentSince Nov 1, 2022 Accepting new patients
Myeyedr Optometry of Florida, LLC Optometrist CurrentSince Jul 1, 2024 Accepting new patients
Myeyedr Optometry of Florida, LLC Optometrist Current Accepting new patients
Myeyedr. Optometry of Florida, LLC Optometrist CurrentSince Jul 1, 2024 Accepting new patients
Park Avenue Ophthalmics, PLLC Optometrist CurrentSince Nov 1, 2022 Accepting new patients

Locations

2269 E Semoran Blvd
Apopka, FL 32703
Phone (407) 886-2093

3011 W Yamato Rd
Ste A19
Boca Raton, FL 33434
Phone (561) 995-9600

3140 Citrus Tower Blvd
Bldg 11
Clermont, FL 34711
Phone (352) 243-2121

2140 Crawfordville Hwy
Crawfordville, FL 32327
Phone (850) 926-9213

13630 Sachs Ave
Ste 120
Orlando, FL 32827
Phone (407) 893-8200

1911 N Mills Ave
Orlando, FL 32803
Phone (407) 893-8200

102 Henry Ave
Plant City, FL 33563
Phone (813) 704-6090

1480 Timberlane Rd
Tallahassee, FL 32312
Phone (850) 878-1601

2301 Wilton Dr
Ste C1
Wilton Manors, FL 33305
Phone (954) 764-6906

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Organizations & group practices 5

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": "1563494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719446400000",
    "number": "1336792290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1911 N MILLS AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328031407",
            "telephone_number": "407-893-8200",
            "fax_number": "407-893-8210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1911 N MILLS AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328031407",
            "telephone_number": "407-893-8200",
            "fax_number": "407-893-8210"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3140 Citrus Tower Blvd Bldg 11",
            "address_purpose": "LOCATION",
            "city": "Clermont",
            "state": "FL",
            "postal_code": "347116888",
            "country_code": "US",
            "telephone_number": "352-243-2121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATEL",
        "first_name": "SHETAL",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-19",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC5717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.