Healthcare Provider Details

I. General information

NPI: 1043002538
Provider Name (Legal Business Name): PRIYA A PATEL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

963 N 129TH INFANTRY DR STE 110
JOLIET IL
60435-3103
US

IV. Provider business mailing address

963 N 129TH INFANTRY DR STE 110
JOLIET IL
60435-3103
US

V. Phone/Fax

Practice location:
  • Phone: 815-729-3777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046012136
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: