Active NPI
Kishan Pankaj Patel, OD
- Optometrist
- Norridge, IL
National Provider Identifier
1952180374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046011796
- Practice address
- 4214 N Harlem Ave
Norridge, IL 60706-1293 - Phone
- (708) 453-7005
- NPI assigned
- Sep 25, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046011796 | IL | Primary |
Addresses
Primary practice location
4214 N Harlem Ave
Norridge, IL 60706-1293
Mailing address
3430 Clearbrook CT
Saugatuck, MI 49453-9488
Phone (201) 360-1671
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046011796 | IL | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Visionworks, Inc | Current | Accepting new patients | |
| Visionworks, Inc. | Optometrist | Current | Accepting new patients |
| Luxottica of America Inc. | Past | Accepting new patients | |
| Luxottica of America Inc | Past | Accepting new patients |
Locations
239 Golf Mill Ctr
Ste 255
Niles, IL 60714
Phone (847) 297-2286
2422 US Highway 34
Oswego, IL 60543
Phone (630) 551-4133
19100 Ridgewood Pkwy
Bldg 1
San Antonio, TX 78259
Phone (726) 444-4069
Organizations & group practices 4
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1695600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695600000000",
"number": "1952180374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3430 CLEARBROOK CT",
"city": "SAUGATUCK",
"state": "MI",
"postal_code": "494539488",
"telephone_number": "201-360-1671"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4214 N HARLEM AVE",
"city": "NORRIDGE",
"state": "IL",
"postal_code": "607061293",
"telephone_number": "708-453-7005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATEL",
"first_name": "KISHAN",
"middle_name": "PANKAJ",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-09-25",
"last_updated": "2023-09-25",
"certification_date": "2023-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046011796",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Norridge, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2023; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.