Provider Demographics
NPI:1386047116
Name:NORRIS, NICHOLAS (OD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:NORRIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-4234
Mailing Address - Country:US
Mailing Address - Phone:662-332-0163
Mailing Address - Fax:662-378-3394
Practice Address - Street 1:239 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-4234
Practice Address - Country:US
Practice Address - Phone:662-332-0163
Practice Address - Fax:662-378-3394
Is Sole Proprietor?:No
Enumeration Date:2014-10-07
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS907152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist