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NPI Code Detail

MEDICARE: MAANCY MEHTA O.D

MEDICARE: MAANCY MEHTA 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
1152W00000XOptometristTUV008200-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2F400390940OTHERILPTAN
3F400390942OTHERILPTAN
4F400390939OTHERILPTAN
5F400390941OTHERILPTAN

General Provider Information

NPI Number : 1336556083
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAANCY MEHTA O.D
Provider Business Mailing Address
First Line : 329 W 18TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60616-1120
Country : US
Telephone Number : 312-929-3312
Fax Number :
Provider Business Practice Location Address
First Line : 3500 W PETERSON AVE STE 401
Second Line :
City : CHICAGO
State : IL
Zip : 60659-3307
Country : US
Telephone Number : 773-588-3090
Fax Number : 773-588-3210
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2014
Last Update Date : 07/21/2022

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