MEDICARE: GEORGE M NISTA O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	0460068861	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	362893564	OTHER	IL	NIPPON LIFE
2	362893564	OTHER	IL	WAUSAU INSURANCE
3	01633282	OTHER	IL	BCBS OF IL
4	362893564	OTHER	IL	AETNA
5	362893564	OTHER	IL	HUMANA CARE PLAN
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	362893564	OTHER	IL	GROUP ADMINISTRATORS
8	362893564	OTHER	IL	UNICARE
9	362893564	OTHER	IL	CONNECTICUT GENERAL
10	362893564	OTHER	IL	AMERICAN POSTAL WRKRS U
11	362893564	OTHER	IL	UNITED HEALTHCARE MIDWEST
12	362893564	OTHER	IL	GENERAL AMERICAN
13	362893564	OTHER	IL	PACIFIC LIFE
14	362893564	OTHER	IL	HUMANA
15	362893564	OTHER	IL	CIGNA

General Provider Information

NPI Number	:	1043268485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE M NISTA O.D.

Provider Business Mailing Address
First Line	:	3135 W 111TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-2223
Country	:	US
Telephone Number	:	773-233-4448
Fax Number	:	773-233-4401

Provider Business Practice Location Address
First Line	:	3135 W 111TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-2223
Country	:	US
Telephone Number	:	773-233-4448
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	12/30/2011

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