Puja Patel

Primary specialty

OptometristTaxonomy code 152W00000X

License

46011605 Issued in IL

Practice address

4663 W 95TH St
Oak Lawn, IL 60453-2540

Phone

(708) 636-0600

Fax

(708) 636-0606

NPI assigned

Apr 4, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Harold E Davis and Terry Alan Trust EtalGroup PAC ID 1456422070, 4 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Harold E Davis & Terry Alan Trust Etal

  • Optometrist
  • Oak Lawn, IL
  • NPI 1265621361
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718841600000",
    "number": "1568041978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2106 N FROLIC AVE",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600873592",
            "telephone_number": "847-338-7028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4663 W 95TH ST",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532540",
            "telephone_number": "708-636-0600",
            "fax_number": "708-636-0606"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10701 East Blvd",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "441061702",
            "country_code": "US",
            "telephone_number": "216-791-3800 x65177",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATEL",
        "first_name": "PUJA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-04",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "46011605",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimi Patel
• Mitul Rajnikant Patel, DO
• Nandini Patel, DO
• Neil Patel, DPT
• Nicholas Patel
• Reeya Patel, DO
• Rinku J Patel, D.O.
• Ruchita Patel, D.O.
• Samir Patel, MD
• Shirali G. Patel, D.O.

• Optometrist in Oak Lawn, IL
• Providers in Oak Lawn, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.