Basic Information
| Provider Information | |||||||||
| NPI: | 1053780080 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | RIDHI | ||||||||
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| Credential: | O.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 444 N WABASH AVE | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606115622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129457192 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5408 N CLARK ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606401210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732752020 | ||||||||
| FaxNumber: | 7732754167 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2015 | ||||||||
| LastUpdateDate: | 10/10/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 046010914 | IL | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 0163706 | 01 | IL | BCBS | OTHER | 7235044 | 01 | IL | AETNA | OTHER | 8825444 | 01 | IL | MULTIPLAN | OTHER |