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General NPI Number Information
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NPI Number | 1528252673
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Entity Type | Organization
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Legal Business Name | SAMKET VISION GROUP INC
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Dates
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Enumeration Date | 08/31/2007
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Last Update Date | 08/31/2007
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Provider Practice Location Address
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Address Line | 111 N STATE ST
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City | CHICAGO
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State | IL
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Zip | 60602-1659
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Country | US
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Telephone | 312-781-3573
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Fax |
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Provider Business Mailing Address
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Address Line | 6611 WEDGEWOOD LN
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City | WILLOWBROOK
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State | IL
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Zip | 60527-5440
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Country | US
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Telephone | 630-205-9505
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAMIR PATEL
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Credential | O.D
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Telephone | 630-205-9505
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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 | IL
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