Healthcare Provider Details

I. General information

NPI: 1134953227
Provider Name (Legal Business Name): NICOLE FREEMAN MARGASON OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 MAIN ST STE 100
WOODRIDGE IL
60517-1753
US

IV. Provider business mailing address

1656 BROOKDALE RD
NAPERVILLE IL
60563-2127
US

V. Phone/Fax

Practice location:
  • Phone: 630-824-0101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046011912
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: