Provider Demographics
NPI:1225378193
Name:SONI, DIMPLE MUKESH (OD)
Entity Type:Individual
Prefix:DR
First Name:DIMPLE
Middle Name:MUKESH
Last Name:SONI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 LARRY POWER RD
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-5190
Mailing Address - Country:US
Mailing Address - Phone:815-933-5202
Mailing Address - Fax:815-933-6531
Practice Address - Street 1:1602 N STATE ROUTE 50
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-9304
Practice Address - Country:US
Practice Address - Phone:815-932-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010636152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist