Healthcare Provider Details

I. General information

NPI: 1699725119
Provider Name (Legal Business Name): NICHOLS OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4164 E BLUEGRASS RD
MT PLEASANT MI
48858-7967
US

IV. Provider business mailing address

3200 S AIRPORT RD W SUITE 146
TRAVERSE CITY MI
49684-8117
US

V. Phone/Fax

Practice location:
  • Phone: 989-772-9481
  • Fax:
Mailing address:
  • Phone: 231-941-7788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. LORI WIRTH
Title or Position: GENERAL MANAGER
Credential:
Phone: 231-941-7788