Healthcare Provider Details

I. General information

NPI: 1568742633
Provider Name (Legal Business Name): PRIYANKA ERNST O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PRIYANKA PATEL O.D.

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 STONEGATE RD
ALGONQUIN IL
60102-5614
US

IV. Provider business mailing address

1042 N THACKERAY DR
PALATINE IL
60067-2750
US

V. Phone/Fax

Practice location:
  • Phone: 847-658-0120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046010465
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: