MEDICARE: NICOLAS A SOULIER P C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1265805451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICOLAS A SOULIER P C

Provider Business Mailing Address
First Line	:	5229 COLDWATER RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-5538
Country	:	US
Telephone Number	:	260-484-1453
Fax Number	:	260-483-8287

Provider Business Practice Location Address
First Line	:	5229 COLDWATER RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-5538
Country	:	US
Telephone Number	:	260-484-1453
Fax Number	:	260-483-8287

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. NICOLAS A SOULIER
Credential	:	O.D.
Telephone Number	:	260-312-5136

Provider Enumeration Date	:	11/10/2015
Last Update Date	:	02/13/2023

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