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General NPI Number Information
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NPI Number | 1508294117
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Entity Type | Individual
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Provider Name | MR. NICHOLAS R URDIALES
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Gender | Male
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Dates
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Enumeration Date | 10/16/2013
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Last Update Date | 10/16/2013
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Provider Practice Location Address
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Address Line | 1767 LAKEWOOD RANCH BLVD #252
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City | BRADENTON
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State | FL
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Zip | 34211-4906
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Country | US
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Telephone | 973-789-5148
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Fax |
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Provider Business Mailing Address
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Address Line | 3654 CORINTH PKWY
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City | CORINTH
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State | TX
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Zip | 76208-5373
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Country | US
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Telephone | 973-789-5148
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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 | 156FX1700X
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Taxonomy Name | Ocularist
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License Number |
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License Number State | FL
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