Healthcare Provider Details

I. General information

NPI: 1467947770
Provider Name (Legal Business Name): JAY B PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 HUNTINGTON DR N STE A
ALGONQUIN IL
60102-5940
US

IV. Provider business mailing address

3091 US HIGHWAY 20 STE 105
ELGIN IL
60124-3840
US

V. Phone/Fax

Practice location:
  • Phone: 630-888-1152
  • Fax:
Mailing address:
  • Phone: 847-874-2020
  • Fax: 847-423-4372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046.011330
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: