Provider Demographics
NPI:1609924745
Name:NAKAJIMA, TOSHIO (OD)
Entity Type:Individual
Prefix:DR
First Name:TOSHIO
Middle Name:
Last Name:NAKAJIMA
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 1:165 S RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5551
Mailing Address - Country:US
Mailing Address - Phone:847-888-1555
Mailing Address - Fax:847-888-2508
Practice Address - Street 1:165 S RANDALL RD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123
Practice Address - Country:US
Practice Address - Phone:847-888-1555
Practice Address - Fax:847-888-2508
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008123152W00000X
IL046-008123152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL410017896OtherRAILROAD MEDICARE
IL4515286OtherBCBS
ILL08183OtherPIN
IL363546473OtherEIN
IL799670Medicare ID - Type Unspecified
IL0253870001Medicare ID - Type UnspecifiedMEDICARE MATERIALS
ILL08183OtherPIN