Provider Demographics
NPI:1144450495
Name:NIX, ANNALEE NICOLLE (OD)
Entity type:Individual
Prefix:MRS
First Name:ANNALEE
Middle Name:NICOLLE
Last Name:NIX
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANNALEE
Other - Middle Name:NICOLLE
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1450 E NANCY AVE
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-4052
Mailing Address - Country:US
Mailing Address - Phone:602-828-2517
Mailing Address - Fax:
Practice Address - Street 1:1445 W SOUTHERN AVE
Practice Address - Street 2:STE. 2242
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4803
Practice Address - Country:US
Practice Address - Phone:480-345-7520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1699152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist