Provider Demographics
NPI:1134453897
Name:GRISHMA P. PATEL, O.D. & ASSOCIATES, P.C.
Entity type:Organization
Organization Name:GRISHMA P. PATEL, O.D. & ASSOCIATES, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRISHMA
Authorized Official - Middle Name:P
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-668-4144
Mailing Address - Street 1:1325 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3579
Mailing Address - Country:US
Mailing Address - Phone:630-668-4144
Mailing Address - Fax:630-668-7559
Practice Address - Street 1:1325 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3579
Practice Address - Country:US
Practice Address - Phone:630-668-4144
Practice Address - Fax:630-668-7559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009678152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009678Medicaid
IL1134453897Medicaid
IL046009678Medicaid