Provider Demographics
NPI:1841262540
Name:CHIARAMONTI, NICHOLAS ANTHONY (OD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ANTHONY
Last Name:CHIARAMONTI
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 1:1067 S FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4035
Mailing Address - Country:US
Mailing Address - Phone:630-546-8319
Mailing Address - Fax:708-749-2068
Practice Address - Street 1:6233 CERMAK RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2317
Practice Address - Country:US
Practice Address - Phone:708-749-2020
Practice Address - Fax:708-749-2069
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008520152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046008520Medicaid
L28661Medicare PIN
L28692Medicare PIN
ILU45485Medicare UPIN