Provider Demographics
NPI:1982852208
Name:NIKOUMANESH, NASIM (OD)
Entity Type:Individual
Prefix:DR
First Name:NASIM
Middle Name:
Last Name:NIKOUMANESH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:NASIM
Other - Middle Name:
Other - Last Name:NIKOUMANESH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 N LARRABEE ST
Mailing Address - Street 2:OLDTOWN TARGET OPTICAL
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610
Mailing Address - Country:US
Mailing Address - Phone:312-475-0896
Mailing Address - Fax:312-475-0872
Practice Address - Street 1:1200 N LARRABEE ST
Practice Address - Street 2:TARGET OPTICAL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610
Practice Address - Country:US
Practice Address - Phone:312-475-0896
Practice Address - Fax:312-675-0872
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010124152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist