Provider Demographics
NPI:1760151120
Name:SALES, MEGAN (OD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:
Last Name:SALES
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 1:1275 ALEXANDRA BLVD
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-1953
Mailing Address - Country:US
Mailing Address - Phone:815-355-7652
Mailing Address - Fax:
Practice Address - Street 1:2787 MILWAUKEE RD
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-6919
Practice Address - Country:US
Practice Address - Phone:608-365-2512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3704-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist