Provider Demographics
NPI:1457400731
Name:NYBOE, GERI G (OD)
Entity Type:Individual
Prefix:
First Name:GERI
Middle Name:G
Last Name:NYBOE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 IROQUOIS DR
Mailing Address - Street 2:
Mailing Address - City:CLARENDON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514-1124
Mailing Address - Country:US
Mailing Address - Phone:630-655-2451
Mailing Address - Fax:
Practice Address - Street 1:280 OAKBROOK CTR
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1841
Practice Address - Country:US
Practice Address - Phone:630-368-1609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU37095Medicare UPIN
ILL77834Medicare ID - Type Unspecified