Healthcare Provider Details

I. General information

NPI: 1932207529
Provider Name (Legal Business Name): JUNE R. R. NICHOLS OCULARIST, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1767 E OAKTON ST
DES PLAINES IL
60018-2131
US

IV. Provider business mailing address

1767 E OAKTON ST
DES PLAINES IL
60018-2131
US

V. Phone/Fax

Practice location:
  • Phone: 847-803-5050
  • Fax: 847-803-0806
Mailing address:
  • Phone: 847-803-5050
  • Fax: 847-803-0806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES P JOHNSTON
Title or Position: PRESIDENT/CEO
Credential: BCO BADO
Phone: 847-803-5050