Healthcare Provider Details

I. General information

NPI: 1982808937
Provider Name (Legal Business Name): JOHN NICOLAU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N MAIN AVE
SAN ANTONIO TX
78212-4712
US

IV. Provider business mailing address

2191 NW MILITARY HWY
SAN ANTONIO TX
78213-1836
US

V. Phone/Fax

Practice location:
  • Phone: 210-222-2154
  • Fax: 210-227-6056
Mailing address:
  • Phone: 210-348-8788
  • Fax: 210-348-8768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0108X
TaxonomyUveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
License NumberM6803
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberM6803
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberM6803
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: