MEDICARE: PAYAL PATEL O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	13663	CA

General Provider Information

NPI Number	:	1013158674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAYAL PATEL O.D.

Provider Business Mailing Address
First Line	:	5765 NORTHWEST HWY
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-8042
Country	:	US
Telephone Number	:	847-791-0396
Fax Number	:

Provider Business Practice Location Address
First Line	:	5765 NORTHWEST HWY
Second Line	:	VISIONWORKS
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-8042
Country	:	US
Telephone Number	:	847-791-0396
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2009
Last Update Date	:	06/15/2026

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