Individual
DR. NISHA B JANI-KONDURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1114 W DEVON AVE, ELK GROVE VILLAGE, IL 60007-3214
(847) 895-7222
(847) 895-0861
Mailing address
8614 WESTWOOD CENTER DR FL 9, VIENNA, VA 22182-2442
(703) 847-8899
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046008796
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046008796
—
IL
Enumeration date
08/24/2005
Last updated
05/14/2024
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