Provider Demographics
NPI:1215174636
Name:NICOL L. MAYFIELD, OD, PC
Entity type:Organization
Organization Name:NICOL L. MAYFIELD, OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-312-5811
Mailing Address - Street 1:6734 S 163RD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-6392
Mailing Address - Country:US
Mailing Address - Phone:402-891-5752
Mailing Address - Fax:
Practice Address - Street 1:6304 N 99TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-1528
Practice Address - Country:US
Practice Address - Phone:402-492-9440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1125152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty