Provider Demographics
NPI:1336680370
Name:CHOLICO, NATHANIA CAPISTRANO (OD)
Entity type:Individual
Prefix:
First Name:NATHANIA
Middle Name:CAPISTRANO
Last Name:CHOLICO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-223-6840
Mailing Address - Fax:206-223-6965
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-223-6840
Practice Address - Fax:206-223-6965
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002585152W00000X
TN3376152W00000X
WAOD60840465152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist