Provider Demographics
NPI:1326474735
Name:PATEL, LISHA J (OD)
Entity Type:Individual
Prefix:DR
First Name:LISHA
Middle Name:J
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 1:850 S BARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-2255
Mailing Address - Country:US
Mailing Address - Phone:630-372-4974
Mailing Address - Fax:
Practice Address - Street 1:850 S BARRINGTON RD
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-2255
Practice Address - Country:US
Practice Address - Phone:630-372-4974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003820152W00000X
IL046010667152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist