Healthcare Provider Details

I. General information

NPI: 1982687786
Provider Name (Legal Business Name): NICKY YU-CHUN LAI O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 W 10TH AVE
COLUMBUS OH
43210-1280
US

IV. Provider business mailing address

338 W 10TH AVE
COLUMBUS OH
43210-1280
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-2020
  • Fax:
Mailing address:
  • Phone: 614-292-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5398T
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number5398T
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: