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General NPI Number Information
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NPI Number | 1336556083
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Entity Type | Individual
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Provider Name | MAANCY MEHTA O.D
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Gender | Female
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3500 W PETERSON AVE STE 401
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City | CHICAGO
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State | IL
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Zip | 60659-3307
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Country | US
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Telephone | 773-588-3090
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Fax | 773-588-3210
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Provider Business Mailing Address
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Address Line | 329 W 18TH ST
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City | CHICAGO
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State | IL
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Zip | 60616-1120
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Country | US
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Telephone | 312-929-3312
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | TUV008200-1
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License Number State | NY
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