Provider Demographics
NPI:1811424633
Name:SHETH, RINA KAMALESH (DO)
Entity Type:Individual
Prefix:
First Name:RINA
Middle Name:KAMALESH
Last Name:SHETH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 STERLING CT
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60124-5505
Mailing Address - Country:US
Mailing Address - Phone:224-402-3708
Mailing Address - Fax:
Practice Address - Street 1:1331 W 75TH ST STE 403
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-9336
Practice Address - Country:US
Practice Address - Phone:630-357-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011181152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty