Healthcare Provider Details

I. General information

NPI: 1982738183
Provider Name (Legal Business Name): DR. ERIC NICHOLLS AND ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6590 GRAND AVE.
GURNEE IL
60031
US

IV. Provider business mailing address

22961 LONG GROVE RD.
DEER PARK IL
60010
US

V. Phone/Fax

Practice location:
  • Phone: 847-855-1233
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number46009345
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number46009645
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number46009345
License Number StateIL

VIII. Authorized Official

Name: DR. ERIC OWEN NICHOLLS
Title or Position: PRESIDENT
Credential: OD
Phone: 847-858-6748