Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 046009678 | IL |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 046-009678 | IL |
NPI | 1164622874 |
---|---|
Provider Name | Dr. Grishma Premal Patel |
First Address | Wheaton, IL 60187-3579 |
Second Address | Wheaton, IL 60187-3579 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2007 |
Last Update Date | 09/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
046009678 | (05) | IL |