Provider Demographics
NPI:1124357702
Name:NICOSIA CONSULTING LLC
Entity Type:Organization
Organization Name:NICOSIA CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:MARCELLA
Authorized Official - Last Name:NICOSIA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:602-469-1834
Mailing Address - Street 1:6501 E GREENWAY PKWY
Mailing Address - Street 2:STE 103-148
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2065
Mailing Address - Country:US
Mailing Address - Phone:602-469-1834
Mailing Address - Fax:
Practice Address - Street 1:1606 S SIGNAL BUTTE RD
Practice Address - Street 2:VISION CENTER
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-1482
Practice Address - Country:US
Practice Address - Phone:480-358-9737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty