Individual
NICHOLAS WHITESIDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
815 LINCOLN HWY, FAIRVIEW HEIGHTS, IL 62208-2230
(618) 628-8868
Mailing address
815 LINCOLN HWY, FAIRVIEW HEIGHTS, IL 62208-2230
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046.012058
IL
Other
Enumeration date
12/02/2025
Last updated
12/02/2025
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