Provider Demographics
NPI:1417904707
Name:PATEL, SONAL P (OD)
Entity Type:Individual
Prefix:
First Name:SONAL
Middle Name:P
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 1:7257 S JEFFERY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-3014
Mailing Address - Country:US
Mailing Address - Phone:773-493-7040
Mailing Address - Fax:
Practice Address - Street 1:7257 S. JEFFERY BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3306
Practice Address - Country:US
Practice Address - Phone:773-493-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009507152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILV08122Medicare UPIN
IL347300Medicare ID - Type Unspecified
IL206332Medicare ID - Type Unspecified
IL206331Medicare ID - Type Unspecified
IL206330Medicare ID - Type Unspecified