Healthcare Provider Details

I. General information

NPI: 1780676486
Provider Name (Legal Business Name): HEATHER MARIE NICHOLS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 UNIVERSITY RD # MS 7002
SANTA BARBARA CA
93106
US

IV. Provider business mailing address

552 UNIVERSITY RD # MS 7002
SANTA BARBARA CA
93106-7880
US

V. Phone/Fax

Practice location:
  • Phone: 805-893-3170
  • Fax:
Mailing address:
  • Phone: 805-893-3170
  • Fax: 805-893-2952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number11623T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: