Individual
MATTHEW CLARK NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
352 BROWN BLVD, BOURBONNAIS, IL 60914-2458
(815) 932-2020
(815) 937-0060
Mailing address
352 BROWN BLVD, BOURBONNAIS, IL 60914-2458
(815) 932-2020
(815) 937-0060
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046008729
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046008729
—
IL
01
—
346001680
CONTROLLED SUBSTANCE
IL
Enumeration date
08/03/2006
Last updated
03/07/2023
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