Individual provider Active NPI

Mital Patel, O.D.

  • Optometrist
  • Marietta, GA
National Provider Identifier
1760715361
Registry record updated May 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT002478 Issued in GA
Practice address
3535 Roswell Rd Ste 8
Marietta, GA 30062-8827
Phone
(678) 560-8065
NPI assigned
Sep 14, 2009
Last updated
May 3, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT002478 GA Primary

Addresses

Primary practice location

3535 Roswell Rd Ste 8
Marietta, GA 30062-8827

Mailing address

3535 Roswell Rd Ste 8
Marietta, GA 30062-8827
Phone (678) 560-8065

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20100224000447 GA Practitioner - Optometry 2062556301 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2008
Medicare assignment
May accept Medicare assignment
Group practices
Optimist LLCGroup PAC ID 3971851668, 2 clinicians

Practice addresses (Care Compare)

1615 Ridenour Blvd NW
Suite 201
Kennesaw, GA 30152-4464
Phone (770) 499-2020

3535 Roswell Rd
Suite 8
Marietta, GA 30062-8827
Phone (678) 560-8065

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT002478GAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Optimist LLC Optometrist CurrentSince Mar 7, 2018 Accepting new patients
Map Eyes LLC Optometrist CurrentSince Jan 31, 2012 Accepting new patients
Eecarman OD PC Optometrist PastSince Mar 7, 2018 Accepting new patients

Locations

1615 Ridenour Blvd NW
Ste 201
Kennesaw, GA 30152
Phone (770) 499-2020

3535 Roswell Rd
Ste 8
Marietta, GA 30062
Phone (678) 560-8065

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1252886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462233600000",
    "number": "1760715361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 ROSWELL RD STE 8",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300628827",
            "telephone_number": "678-560-8065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 ROSWELL RD STE 8",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300628827",
            "telephone_number": "678-560-8065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "MITAL",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-14",
        "last_updated": "2016-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT002478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.