Provider Demographics
NPI:1629148804
Name:PATEL-GARUD, RACHANA SURESH (OD)
Entity Type:Individual
Prefix:DR
First Name:RACHANA
Middle Name:SURESH
Last Name:PATEL-GARUD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:RACHANA
Other - Middle Name:SURESH
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:811 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3706
Mailing Address - Country:US
Mailing Address - Phone:847-425-0086
Mailing Address - Fax:
Practice Address - Street 1:811 CHURCH ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3706
Practice Address - Country:US
Practice Address - Phone:847-425-0086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.009928152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00434967OtherMEDICARE RAILROAD
IL046009928Medicaid
IL7215175OtherBCBS
ILK28941Medicare PIN
ILP00434967OtherMEDICARE RAILROAD