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General NPI Number Information
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NPI Number | 1487789913
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Entity Type | Organization
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Legal Business Name | NICHOLAS EYE CLINIC, PLLC
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 02/04/2010
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Provider Practice Location Address
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Address Line | 1204 W WILLOW RD SUITE A
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City | ENID
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State | OK
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Zip | 73703-2531
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Country | US
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Telephone | 580-234-2333
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Fax | 580-234-0820
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Provider Business Mailing Address
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Address Line | 1204 W WILLOW RD SUITE A
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City | ENID
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State | OK
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Zip | 73703-2531
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Country | US
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Telephone | 580-234-2333
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Fax | 580-234-0820
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | VALARIE NICHOLAS
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Credential |
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Telephone | 580-234-2333
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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 |
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License Number State |
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