Provider Demographics
NPI:1780775973
Name:NICHOL, MELANIE PATRICIA (OD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:PATRICIA
Last Name:NICHOL
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 1:7749 W HOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3806
Mailing Address - Country:US
Mailing Address - Phone:773-255-5601
Mailing Address - Fax:773-763-6297
Practice Address - Street 1:999 N ELMHURST RD
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-1135
Practice Address - Country:US
Practice Address - Phone:847-660-2003
Practice Address - Fax:847-660-2029
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
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
ILU78014Medicare ID - Type Unspecified