Basic Information
| Provider Information | |||||||||
| NPI: | 1912348517 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | PRIYA | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1110 W 15TH ST UNIT 215 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606083194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154511481 | ||||||||
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| Practice Location | |||||||||
| Address1: | 266 YORKTOWN CENTER | ||||||||
| Address2: | VISIONWORKS | ||||||||
| City: | LOMBARD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302611867 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2013 | ||||||||
| LastUpdateDate: | 07/11/2013 | ||||||||
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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 | 046010665 | IL | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.