Provider Demographics
NPI:1730251612
Name:CASPER, NANCY J (OD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:CASPER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 ONTARIO ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-5000
Mailing Address - Country:US
Mailing Address - Phone:768-386-0626
Mailing Address - Fax:
Practice Address - Street 1:9450 SKOKIE BLVD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1311
Practice Address - Country:US
Practice Address - Phone:847-677-7202
Practice Address - Fax:847-677-1258
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU38613Medicare UPIN