Provider Demographics
NPI:1023245412
Name:GULATI, NEHA CHAUDHARY (OD)
Entity type:Individual
Prefix:
First Name:NEHA
Middle Name:CHAUDHARY
Last Name:GULATI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:NEHA
Other - Middle Name:
Other - Last Name:CHAUDHARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1870 SILVER CROSS BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-8640
Mailing Address - Country:US
Mailing Address - Phone:815-485-2727
Mailing Address - Fax:815-485-3034
Practice Address - Street 1:1870 SILVER CROSS BLVD STE 110
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-8640
Practice Address - Country:US
Practice Address - Phone:815-485-2727
Practice Address - Fax:815-485-3034
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004667152W00000X
IL046010324152WL0500X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P32140006Medicare PIN