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NPI Code Detail

MEDICARE: DAVID S NICHOLS M.D.

MEDICARE:   DAVID S 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
1207W00000XOphthalmology PhysicianME0043731FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10049901OTHERNYGHI
24091614OTHERFLAETNA
30805216OTHERFLUNITED HEALTHCARE
430744OTHERFLBCBS FLORIDA
52074201OTHERFLAETNA

General Provider Information

NPI Number : 1154328920
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID S NICHOLS M.D.
Provider Business Mailing Address
First Line : 403 VONDERBURG DR
Second Line : STE 101
City : BRANDON
State : FL
Zip : 33511-5982
Country : US
Telephone Number : 813-681-1122
Fax Number : 813-684-4924
Provider Business Practice Location Address
First Line : 403 VONDERBURG DR
Second Line : STE 101
City : BRANDON
State : FL
Zip : 33511-5982
Country : US
Telephone Number : 813-681-1122
Fax Number : 813-684-4924
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 09/07/2016

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Practice Location Address:
403 VONDERBURG DR , STE 101
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1598762395 — LESLIE R ALONZO III O.D.
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33511-5982
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Practice Fax: 813-684-4924
1194723742 — WILLIAM A REEVES M.D.
Practice Location Address:
403 VONDERBURG DR
BRANDON, FL
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1659371441 — MARGUERITE MARY KOHLHEPP MD
Practice Location Address:
403 VONDERBURG DR
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1306839725 — GREGORY L HENDERSON MD FACS INC
Practice Location Address:
403 VONDERBURG DR
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33511-5982
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Practice Fax: 813-684-4924

Directions to “ DAVID S NICHOLS M.D.” Practice Location

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