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General NPI Number Information
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NPI Number | 1073334595
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Entity Type | Organization
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Legal Business Name | MELROSE PARK EYE CARE LLC
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 904 W NORTH AVE
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City | MELROSE PARK
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State | IL
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Zip | 60160-1520
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Country | US
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Telephone | 708-343-9009
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 CHATHAM RD STE R
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4188
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAJAL PATEL DARNE
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Credential | OD
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Telephone | 832-607-2055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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