MEDICARE: NICHOLAS MARTIN ONKEN 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	R-237-TA-A03	AL

General Provider Information

NPI Number	:	1639506397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS MARTIN ONKEN O.D.

Provider Business Mailing Address
First Line	:	1950 OLD GALLOWS RD STE 520
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-3970
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2019 HIGHLAND AVE S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-3801
Country	:	US
Telephone Number	:	205-328-2020
Fax Number	:	205-918-9096

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

Provider Enumeration Date	:	09/26/2013
Last Update Date	:	02/22/2022

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