Provider Demographics
NPI:1831827716
Name:GARCIA, NICHOLAS MANUEL (OD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:MANUEL
Last Name:GARCIA
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 1:2457 W LOGAN BLVD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1973
Mailing Address - Country:US
Mailing Address - Phone:812-223-6119
Mailing Address - Fax:
Practice Address - Street 1:1400 W 47TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-3232
Practice Address - Country:US
Practice Address - Phone:773-579-1588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011666152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist