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General NPI Number Information
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NPI Number | 1992437503
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Entity Type | Individual
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Provider Name | KOURY NICOLE THOMAS OD
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Gender | Female
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Dates
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Enumeration Date | 06/30/2022
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 795 E MARSHALL ST STE 103
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City | WEST CHESTER
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State | PA
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Zip | 19380-4400
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Country | US
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Telephone | 610-429-3004
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Fax |
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Provider Business Mailing Address
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Address Line | 430 DRUMMERS LN
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City | WAYNE
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State | PA
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Zip | 19087-1562
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Country | US
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Telephone | 267-838-2962
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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 | OEG003902
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License Number State | PA
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