Healthcare Provider Details

I. General information

NPI: 1750692877
Provider Name (Legal Business Name): DOUGLAS PRIMARY EYE CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

549 E 10TH ST
DOUGLAS AZ
85607-2009
US

IV. Provider business mailing address

549 E 10TH ST
DOUGLAS AZ
85607-2009
US

V. Phone/Fax

Practice location:
  • Phone: 520-364-3892
  • Fax: 520-805-4427
Mailing address:
  • Phone: 520-364-3892
  • Fax: 520-805-4427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: KATRINA ANNE NICHOLS
Title or Position: OWNER
Credential: OD
Phone: 520-364-3892