Provider Demographics
NPI:1730236589
Name:CARO, NICHOLAS CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:CHARLES
Last Name:CARO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4151 W PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-6002
Mailing Address - Country:US
Mailing Address - Phone:773-685-5606
Mailing Address - Fax:773-685-6559
Practice Address - Street 1:4151 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-6002
Practice Address - Country:US
Practice Address - Phone:773-685-5606
Practice Address - Fax:773-685-6559
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-061321207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1617766OtherBLUE CROSS BLUE SHIELD
IL1617766OtherBLUE CROSS BLUE SHIELD
ILD89940Medicare UPIN