Provider Demographics
NPI:1407293533
Name:PATEL, TRISHA H (OD)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:H
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 1:7222 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1422
Mailing Address - Country:US
Mailing Address - Phone:708-447-1494
Mailing Address - Fax:708-447-6178
Practice Address - Street 1:7222 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:NORTH RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-1422
Practice Address - Country:US
Practice Address - Phone:708-447-1494
Practice Address - Fax:708-447-6178
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010646152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist