Provider Demographics
NPI:1376690784
Name:CHIKARAISHI, JAMES K (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:K
Last Name:CHIKARAISHI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3232 W BRYN MAWR AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3606
Mailing Address - Country:US
Mailing Address - Phone:773-588-4433
Mailing Address - Fax:773-463-5361
Practice Address - Street 1:3232 W BRYN MAWR AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3606
Practice Address - Country:US
Practice Address - Phone:773-588-4433
Practice Address - Fax:773-463-5361
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46-6656152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL553880Medicare ID - Type Unspecified
ILT37489Medicare UPIN