Provider Demographics
NPI:1114288644
Name:JUNE R. R. NICHOLS OCULARIST, LTD
Entity Type:Organization
Organization Name:JUNE R. R. NICHOLS OCULARIST, LTD
Other - Org Name:OCULARISTS, LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:BCO BADO
Authorized Official - Phone:847-803-5050
Mailing Address - Street 1:1767 E OAKTON ST
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-2131
Mailing Address - Country:US
Mailing Address - Phone:847-803-5050
Mailing Address - Fax:847-803-0806
Practice Address - Street 1:450 ST. JOHN ROAD
Practice Address - Street 2:SUITE 396
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360
Practice Address - Country:US
Practice Address - Phone:219-874-7236
Practice Address - Fax:847-803-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332H00000XSuppliersEyewear Supplier
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL0140180001Medicare NSC