Healthcare Provider Details

I. General information

NPI: 1487962338
Provider Name (Legal Business Name): NICHOLAS S. APPLEMAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 MAGNOLIA CIR 325 MEDICAL GROUP/SGPE
TYNDALL AFB FL
32403-5604
US

IV. Provider business mailing address

340 MAGNOLIA CIRCLE 325 MEDICAL GROUP/SGPE
TYNDALL AFB FL
32403
US

V. Phone/Fax

Practice location:
  • Phone: 850-283-7005
  • Fax:
Mailing address:
  • Phone: 850-283-7005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618001990
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG002375
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: