Provider Demographics
NPI:1407474166
Name:MEHTA, NIKI (OD)
Entity Type:Individual
Prefix:
First Name:NIKI
Middle Name:
Last Name:MEHTA
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 1:17W410 22ND ST
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4401
Mailing Address - Country:US
Mailing Address - Phone:630-530-2020
Mailing Address - Fax:
Practice Address - Street 1:17W410 22ND ST
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4401
Practice Address - Country:US
Practice Address - Phone:630-530-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011452152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist