Organization
RICARDO JOSE NIEVES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARI GOUDY (OFFICE MANAGER)
(773) 292-8254
Entity
Organization
Contact information
Practice address
1044 N FRANCISCO AVE, CHICAGO, IL 60622-2743
(773) 292-8254
Mailing address
4230 W 26TH ST, CHICAGO, IL 60623-4316
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036089692
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036089692
—
IL
01
—
1912456195
NPI
IL
Enumeration date
09/28/2016
Last updated
10/11/2016
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