Provider Demographics
NPI:1780402156
Name:NIXON, NAOMI J (OD)
Entity type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:J
Last Name:NIXON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2541 W DIVISION ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-0337
Mailing Address - Country:US
Mailing Address - Phone:773-370-2672
Mailing Address - Fax:312-929-3341
Practice Address - Street 1:329 W 18TH ST STE 311
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-5132
Practice Address - Country:US
Practice Address - Phone:312-929-3340
Practice Address - Fax:312-929-3341
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.011920152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist