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General NPI Number Information
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NPI Number | 1225652654
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Entity Type | Individual
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Provider Name | KYLE WAYNE NICHOLS OD
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Gender | Male
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Dates
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Enumeration Date | 06/01/2020
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 5 MYERS DR STE 101
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City | MULLICA HILL
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State | NJ
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Zip | 08062-9517
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Country | US
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Telephone | 856-845-7968
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Fax |
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Provider Business Mailing Address
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Address Line | 3046 KNIGHTS RD
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City | BENSALEM
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State | PA
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Zip | 19020-2815
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Country | US
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Telephone | 215-639-4500
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Fax | 215-604-0355
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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 | OEG003675
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00711200
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License Number State | NJ
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