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General NPI Number Information
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NPI Number | 1528320959
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Entity Type | Individual
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Provider Name | JESSICA R NICHOLS O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/12/2012
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 22414 W 66TH ST
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City | SHAWNEE
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State | KS
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Zip | 66226-3514
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Country | US
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Telephone | 913-441-3838
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Fax | 913-441-3938
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Provider Business Mailing Address
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Address Line | 13818 W 80TH TER
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City | LENEXA
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State | KS
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Zip | 66215-2418
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Country | US
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Telephone | 785-691-5407
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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 | 1924
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License Number State | KS
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