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NPI Code Detail

MEDICARE: DON W NICHOLSON OD

MEDICARE: DON W NICHOLSON OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist04401TTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
181X051OTHERTXBLUE SHIELD

General Provider Information

NPI Number : 1043270432
Entity Type Code : Individual
Provider Name (Legal Business Name) : DON W NICHOLSON OD
Provider Business Mailing Address
First Line : PO BOX 844658
Second Line :
City : DALLAS
State : TX
Zip : 75284-4658
Country : US
Telephone Number : 254-724-8800
Fax Number :
Provider Business Practice Location Address
First Line : 900 SCOTT AND WHITE DR
Second Line :
City : COLLEGE STATION
State : TX
Zip : 77845-6419
Country : US
Telephone Number : 979-207-7400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2006
Last Update Date : 07/02/2025

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