Provider Demographics
NPI:1386267045
Name:NIKOLOVA, GALINA
Entity type:Individual
Prefix:
First Name:GALINA
Middle Name:
Last Name:NIKOLOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 DOROTHY DR
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-5711
Mailing Address - Country:US
Mailing Address - Phone:847-693-1327
Mailing Address - Fax:
Practice Address - Street 1:117 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-2133
Practice Address - Country:US
Practice Address - Phone:630-860-5066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011408152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist