Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 046.011232 | IL |
NPI | 1013498278 |
---|---|
Provider Name | Dr. Sara Nisar |
First Address | Addison, IL 60101-6403 |
Second Address | North Chicago, IL 60064-3048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2018 |
Last Update Date | 27/03/2019 |