Provider Demographics
NPI:1598150898
Name:NICHOLAS RUTKOWSKI, O.D. & ASSOCIATES LLC
Entity Type:Organization
Organization Name:NICHOLAS RUTKOWSKI, O.D. & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-285-1270
Mailing Address - Street 1:870 N CONVENT ST
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1300
Mailing Address - Country:US
Mailing Address - Phone:815-217-9266
Mailing Address - Fax:815-301-3440
Practice Address - Street 1:870 N CONVENT ST
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1300
Practice Address - Country:US
Practice Address - Phone:815-217-9266
Practice Address - Fax:815-301-3440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-010357152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty