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Individual

MAANCY MEHTA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
O.D

Contact information

Practice address
3500 W PETERSON AVE STE 401, CHICAGO, IL 60659-3307
(773) 588-3090
(773) 588-3210
Mailing address
329 W 18TH ST, CHICAGO, IL 60616-1120
(312) 929-3312

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV008200-1
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
046011068
IL
01
F400390939
PTAN
IL
01
F400390940
PTAN
IL
01
F400390941
PTAN
IL
01
F400390942
PTAN
IL
Enumeration date
07/15/2014
Last updated
07/21/2022
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