Provider Demographics
NPI:1275234866
Name:NIKOUMANESH EYE CARE LLC
Entity Type:Organization
Organization Name:NIKOUMANESH EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NASIM
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKOUMANESH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-395-3225
Mailing Address - Street 1:230 W DIVISION ST APT 704
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-7687
Mailing Address - Country:US
Mailing Address - Phone:734-395-3225
Mailing Address - Fax:
Practice Address - Street 1:1200 N LARRABEE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-1746
Practice Address - Country:US
Practice Address - Phone:312-475-0896
Practice Address - Fax:312-675-0872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty