MEDICARE: SONAL P 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	046009507	IL

General Provider Information

NPI Number	:	1417904707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONAL P PATEL O.D

Provider Business Mailing Address
First Line	:	7257 S JEFFERY BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-3014
Country	:	US
Telephone Number	:	773-493-7040
Fax Number	:

Provider Business Practice Location Address
First Line	:	7257 S. JEFFERY BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-3306
Country	:	US
Telephone Number	:	773-493-7040
Fax Number	:

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	11/03/2014

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