Provider Demographics
NPI:1093773285
Name:NICHOLS, KATRINA ANNE (OD)
Entity type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:ANNE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14615 E CIRCLE L RANCH PL
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-8939
Mailing Address - Country:US
Mailing Address - Phone:520-349-3296
Mailing Address - Fax:
Practice Address - Street 1:549 E 10TH ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607-2009
Practice Address - Country:US
Practice Address - Phone:520-364-3892
Practice Address - Fax:520-805-4427
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1370152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist