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General NPI Number Information
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NPI Number | 1780676486
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Entity Type | Individual
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Provider Name | HEATHER MARIE NICHOLS O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/18/2005
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Last Update Date | 07/29/2019
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Provider Practice Location Address
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Address Line | 552 UNIVERSITY RD # MS 7002
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City | SANTA BARBARA
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State | CA
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Zip | 93106
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Country | US
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Telephone | 805-893-3170
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Fax |
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Provider Business Mailing Address
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Address Line | 552 UNIVERSITY RD # MS 7002
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City | SANTA BARBARA
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State | CA
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Zip | 93106-7880
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Country | US
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Telephone | 805-893-3170
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Fax | 805-893-2952
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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 | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 11623T
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License Number State | CA
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