Provider Demographics
NPI:1003003682
Name:NICHOLSON, LAURIE F (OD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:F
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:F
Other - Last Name:NICHOLSON WEXLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6010 S HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4251
Mailing Address - Country:US
Mailing Address - Phone:303-721-9666
Mailing Address - Fax:
Practice Address - Street 1:6010 S HOLLY ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4251
Practice Address - Country:US
Practice Address - Phone:303-721-9666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1486152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist