Individual
KAVITA PATEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
8309 N KNOXVILLE AVE STE 1, PEORIA, IL 61615-2171
(309) 713-3664
Mailing address
8309 N KNOXVILLE AVE, PEORIA, IL 61615-2170
(309) 693-9540
(309) 306-9001
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046011463
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046011463
—
IL
Enumeration date
04/26/2020
Last updated
08/13/2020
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