MEDICARE: DR. VLADA Z NAKHLIS O.D.

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	152W00000X	Optometrist	046-009694	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	IL 9694	OTHER	IL	EYEMED PROVIDER #

General Provider Information

NPI Number	:	1740491455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VLADA Z NAKHLIS O.D.

Provider Business Mailing Address
First Line	:	782 W OAKTON ST
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60018-1857
Country	:	US
Telephone Number	:	224-236-2020
Fax Number	:	224-236-2021

Provider Business Practice Location Address
First Line	:	782 W OAKTON ST
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60018-1857
Country	:	US
Telephone Number	:	224-236-2020
Fax Number	:	224-236-2021

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	03/07/2023

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