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General NPI Number Information
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NPI Number | 1619380755
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Entity Type | Individual
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Provider Name | SONALI PATEL O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/06/2014
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Last Update Date | 11/10/2020
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Provider Practice Location Address
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Address Line | W225N16711 CEDAR PARK CT
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City | JACKSON
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State | WI
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Zip | 53037-9222
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Country | US
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Telephone | 262-677-1101
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Fax | 262-677-0121
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Provider Business Mailing Address
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Address Line | W225N16711 CEDAR PARK CT
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City | JACKSON
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State | WI
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Zip | 53037-9222
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Country | US
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Telephone | 262-677-1101
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Fax | 262-677-0121
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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 | 18004015A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046.010774
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License Number State | IL
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