Provider Demographics
NPI:1982860557
Name:ERDMAN, NATHANIEL M (OD)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:M
Last Name:ERDMAN
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 1:4053 N SHERIDAN RD
Mailing Address - Street 2:UNIT 5
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2086
Mailing Address - Country:US
Mailing Address - Phone:314-369-2219
Mailing Address - Fax:
Practice Address - Street 1:4053 N SHERIDAN RD
Practice Address - Street 2:UNIT 5
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2086
Practice Address - Country:US
Practice Address - Phone:314-369-2219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010139152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist