Provider Demographics
NPI:1982852208
Name:NIKOUMANESH, NASIM (OD)
Entity Type:Individual
Prefix:
First Name:NASIM
Middle Name:
Last Name:NIKOUMANESH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:NASIM
Other - Middle Name:N
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3333 W TOUHY AVE
Mailing Address - Street 2:LINCOLDWOOD TOWN CTR
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-2721
Mailing Address - Country:US
Mailing Address - Phone:847-675-8637
Mailing Address - Fax:
Practice Address - Street 1:3333 W TOUHY AVE
Practice Address - Street 2:LINCOLDWOOD TOWN CTR
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-2721
Practice Address - Country:US
Practice Address - Phone:847-675-8637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010124152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist