Provider Demographics
NPI:1588282156
Name:PATEL, VRAJIKA (OD)
Entity type:Individual
Prefix:
First Name:VRAJIKA
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 1:912 W CHICAGO AVE UNIT 401
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-5674
Mailing Address - Country:US
Mailing Address - Phone:847-858-2322
Mailing Address - Fax:
Practice Address - Street 1:3125 S ASHLAND AVE STE 204
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-6231
Practice Address - Country:US
Practice Address - Phone:773-890-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOP2000557152W00000X
IL046.011459152W00000X
FLTPOP114152W00000X
IA119109152W00000X
MN3867152W00000X
VA0618003157152W00000X
WI3900-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist