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General NPI Number Information
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NPI Number | 1982852208
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Entity Type | Individual
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Provider Name | NASIM NIKOUMANESH O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/28/2008
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Last Update Date | 01/11/2026
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Provider Practice Location Address
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Address Line | 1200 N LARRABEE ST TARGET OPTICAL
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City | CHICAGO
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State | IL
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Zip | 60610
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Country | US
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Telephone | 312-475-0896
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Fax | 312-477-2151
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Provider Business Mailing Address
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Address Line | 1440 W TAYLOR ST STE 4152
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City | CHICAGO
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State | IL
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Zip | 60607-4623
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Country | US
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Telephone | 312-475-0896
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Fax | 312-477-2151
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 046010124
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License Number State | IL
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