Provider Demographics
NPI:1487789913
Name:NICHOLAS EYE CLINIC, PLLC
Entity type:Organization
Organization Name:NICHOLAS EYE CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VALARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-234-2333
Mailing Address - Street 1:1204 W WILLOW RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-2531
Mailing Address - Country:US
Mailing Address - Phone:580-234-2333
Mailing Address - Fax:580-234-0820
Practice Address - Street 1:1204 W WILLOW RD
Practice Address - Street 2:SUITE A
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-2531
Practice Address - Country:US
Practice Address - Phone:580-234-2333
Practice Address - Fax:580-234-0820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK410044611OtherRAILROAD MEDICARE
OK410044611OtherRAILROAD MEDICARE
OK4037830001Medicare NSC