Individual
DR. TEJAL S PATEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
7715 N GRAND PRAIRIE DR, PEORIA, IL 61615-9243
(309) 691-1320
(309) 691-1344
Mailing address
8309 N KNOXVILLE AVE, PEORIA, IL 61615-2170
(309) 693-9540
(309) 693-9542
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046009810
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046009810
ILLINOIS DPA LICENSE
IL
05
—
046009810
—
IL
01
—
P00261601
MEDICARE RAILROAD
IL
Enumeration date
09/30/2005
Last updated
01/10/2014
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