Provider Demographics
NPI:1295022127
Name:PATEL, POONAM (OD)
Entity Type:Individual
Prefix:DR
First Name:POONAM
Middle Name:
Last Name:PATEL
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 1:903 CHRISTA CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3079
Mailing Address - Country:US
Mailing Address - Phone:847-912-5288
Mailing Address - Fax:
Practice Address - Street 1:850 E GOLF RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4502
Practice Address - Country:US
Practice Address - Phone:847-519-1020
Practice Address - Fax:847-519-0626
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004691152W00000X
IL046010453152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist