Provider Demographics
NPI:1619380755
Name:PATEL, SONALI (OD)
Entity Type:Individual
Prefix:MS
First Name:SONALI
Middle Name:
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:W225N16711 CEDAR PARK CT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WI
Mailing Address - Zip Code:53037-9222
Mailing Address - Country:US
Mailing Address - Phone:262-677-1101
Mailing Address - Fax:262-677-0121
Practice Address - Street 1:W225N16711 CEDAR PARK CT
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WI
Practice Address - Zip Code:53037-9222
Practice Address - Country:US
Practice Address - Phone:262-677-1101
Practice Address - Fax:262-677-0121
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004015A152W00000X
IL046.010774152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300002146Medicaid