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General NPI Number Information
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NPI Number | 1093773285
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Entity Type | Individual
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Provider Name | KATRINA ANNE NICHOLS OD
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Gender | Female
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 549 E 10TH ST
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City | DOUGLAS
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State | AZ
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Zip | 85607-2009
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Country | US
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Telephone | 520-364-3892
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Fax | 520-805-4427
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Provider Business Mailing Address
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Address Line | 14615 E CIRCLE L RANCH PL
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City | VAIL
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State | AZ
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Zip | 85641-8939
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Country | US
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Telephone | 520-349-3296
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1370
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License Number State | AZ
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