Provider Demographics
NPI:1184027146
Name:NICOLE S. TAYLOR, O.D., PLLC
Entity Type:Organization
Organization Name:NICOLE S. TAYLOR, O.D., PLLC
Other - Org Name:TAYLOR FAMILY VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:SIMPKINS
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:479-996-2400
Mailing Address - Street 1:820 DEERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72936-6612
Mailing Address - Country:US
Mailing Address - Phone:479-996-9468
Mailing Address - Fax:
Practice Address - Street 1:1268 W CENTER ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:AR
Practice Address - Zip Code:72936-3716
Practice Address - Country:US
Practice Address - Phone:479-996-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2480152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty