Individual
GEORGE M NISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3135 W 111TH ST, CHICAGO, IL 60655-2223
(773) 233-4448
Mailing address
3135 W 111TH ST, CHICAGO, IL 60655-2223
(773) 233-4448
(773) 233-4401
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0460068861
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01633282
BCBS OF IL
IL
05
—
0460068861
—
IL
01
—
362893564
NIPPON LIFE
IL
Enumeration date
05/05/2006
Last updated
12/30/2011
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