Provider Demographics
NPI:1467947770
Name:PATEL, JAY B
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:B
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 HUNTINGTON DR N STE A
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5940
Mailing Address - Country:US
Mailing Address - Phone:847-854-5700
Mailing Address - Fax:
Practice Address - Street 1:2100 HUNTINGTON DR N STE A
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5940
Practice Address - Country:US
Practice Address - Phone:630-888-1152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-28
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.011330152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist