Basic Information
| Provider Information | |||||||||
| NPI: | 1992050967 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DESAI | ||||||||
| FirstName: | PUJA | ||||||||
| MiddleName: | H. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 950 W. RT. 22 | ||||||||
| Address2: | |||||||||
| City: | LAKE ZURICH | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477262020 | ||||||||
| FaxNumber: | 8477262036 | ||||||||
| Practice Location | |||||||||
| Address1: | 950 WEST ROUTE 22 | ||||||||
| Address2: | SUITE 125 | ||||||||
| City: | LAKE ZURICH | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600473417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477262020 | ||||||||
| FaxNumber: | 8477262036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2012 | ||||||||
| LastUpdateDate: | 09/25/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 046010565 | IL | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.