Provider Demographics
NPI:1114455508
Name:MIKELS, NICOLE (OD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:MIKELS
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 1:506 S COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-1875
Mailing Address - Country:US
Mailing Address - Phone:574-586-5531
Mailing Address - Fax:
Practice Address - Street 1:506 S COUNTRY LN
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-1875
Practice Address - Country:US
Practice Address - Phone:574-586-5531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004019A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist