MEDICARE: ERIN ELIABETH NICHOLS M.D.

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
1	207W00000X	Ophthalmology Physician	35.138536	OH

General Provider Information

NPI Number	:	1053774489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN ELIABETH NICHOLS M.D.

Provider Business Mailing Address
First Line	:	8140 NORTON PKWY STE 110
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-6017
Country	:	US
Telephone Number	:	440-255-1115
Fax Number	:	440-255-1550

Provider Business Practice Location Address
First Line	:	8140 NORTON PKWY STE 110
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-6017
Country	:	US
Telephone Number	:	440-255-1115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2016
Last Update Date	:	10/28/2024

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