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General NPI Number Information
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NPI Number | 1952749178
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Entity Type | Organization
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Legal Business Name | AMI PATEL OD INC
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Dates
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Enumeration Date | 06/10/2013
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Last Update Date | 06/10/2013
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Provider Practice Location Address
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Address Line | 1200 E 53RD ST
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City | CHICAGO
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State | IL
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Zip | 60615-4008
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Country | US
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Telephone | 773-493-8372
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Fax | 773-493-9485
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Provider Business Mailing Address
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Address Line | 1200 E 53RD ST
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City | CHICAGO
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State | IL
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Zip | 60615-4008
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Country | US
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Telephone | 773-493-8372
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Fax | 773-493-9485
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | BRENDA COLLIER
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Credential |
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Telephone | 815-634-8597
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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 | 046010011
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License Number State | IL
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