MEDICARE: DR. SARA KRISTEN NICHOLSON O.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	152W00000X	Optometrist	2990-035	WI

General Provider Information

NPI Number	:	1184682775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARA KRISTEN NICHOLSON O.D.

Provider Business Mailing Address
First Line	:	1534 COLLEGE AVE
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53403-1949
Country	:	US
Telephone Number	:	262-989-9629
Fax Number	:

Provider Business Practice Location Address
First Line	:	4060 N MAIN ST
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53402-3121
Country	:	US
Telephone Number	:	262-752-2020
Fax Number	:	262-292-5019

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	06/24/2008

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