Provider Demographics
NPI:1366504763
Name:SARAI, PEPSI SATPAL (OD)
Entity type:Individual
Prefix:DR
First Name:PEPSI
Middle Name:SATPAL
Last Name:SARAI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:SATPAL
Other - Middle Name:P
Other - Last Name:SARAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1116 W TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4214
Mailing Address - Country:US
Mailing Address - Phone:312-829-6173
Mailing Address - Fax:312-829-3504
Practice Address - Street 1:1116 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4214
Practice Address - Country:US
Practice Address - Phone:312-829-6173
Practice Address - Fax:312-829-3504
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009595152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046-009595OtherSTATE LICENSE #
IL7008587OtherAETNA
9485960OtherMULTIPLAN
IL01636791OtherBLUE CROSS BLUE SHIELD
ILIL9595OtherEYEMED VISION CARE
ILIL9595OtherEYEMED VISION CARE
ILK35746Medicare PIN