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General NPI Number Information
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NPI Number | 1598150898
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Entity Type | Organization
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Legal Business Name | NICHOLAS RUTKOWSKI, O.D. & ASSOCIATES LLC
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Dates
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Enumeration Date | 04/02/2015
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Last Update Date | 06/30/2021
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Provider Practice Location Address
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Address Line | 870 N CONVENT ST
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City | BOURBONNAIS
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State | IL
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Zip | 60914-1300
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Country | US
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Telephone | 815-217-9266
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Fax | 815-301-3440
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Provider Business Mailing Address
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Address Line | 870 N CONVENT ST
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City | BOURBONNAIS
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State | IL
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Zip | 60914-1300
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Country | US
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Telephone | 815-217-9266
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Fax | 815-301-3440
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Authorized Official
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Title or Position | CEO
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Name | DR. NICHOLAS RUTKOWSKI
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Credential | O.D.
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Telephone | 708-285-1270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046-010357
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License Number State | IL
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