MEDICARE: MR. TODD MATTHEW NICKEL D. O.

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	L8457	TX
2	207W00000X	Ophthalmology Physician	DR.0073947	CO

General Provider Information

NPI Number	:	1760485627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TODD MATTHEW NICKEL D. O.

Provider Business Mailing Address
First Line	:	PO BOX 4330
Second Line	:
City	:	AVON
State	:	CO
Zip	:	81620-4330
Country	:	US
Telephone Number	:	970-926-6340
Fax Number	:	970-926-6348

Provider Business Practice Location Address
First Line	:	50 BUCK CREEK RD STE 200
Second Line	:
City	:	AVON
State	:	CO
Zip	:	81620-5428
Country	:	US
Telephone Number	:	970-926-6340
Fax Number	:	970-926-6348

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	03/27/2026

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