Basic Information
| Provider Information | |||||||||
| NPI: | 1275678013 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NIERMAN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1644 PERENNIAL LN | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600352356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476078215 | ||||||||
| FaxNumber: | 8474596696 | ||||||||
| Practice Location | |||||||||
| Address1: | 151 MCHENRY RD | ||||||||
| Address2: | |||||||||
| City: | BUFFALO GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600891796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474596626 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | IL | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.