MEDICARE: NIERMAN NIERMAN & NIERMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS0132X	Ophthalmologic Surgery Clinic/Center	0046006885	IL

General Provider Information

NPI Number	:	1184896219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIERMAN NIERMAN & NIERMAN

Provider Business Mailing Address
First Line	:	151 MCHENRY RD
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-1796
Country	:	US
Telephone Number	:	847-459-6626
Fax Number	:	847-459-6696

Provider Business Practice Location Address
First Line	:	151 MCHENRY RD
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-1796
Country	:	US
Telephone Number	:	847-459-6626
Fax Number	:	847-459-6696

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. LAWRENCE HOWARD NIERMAN
Credential	:	OD
Telephone Number	:	847-459-6626

Provider Enumeration Date	:	03/28/2008
Last Update Date	:	02/12/2010

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