Provider Demographics
NPI:1225098841
Name:NICHOLSON, CHRISTINE R (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:R
Last Name:NICHOLSON
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 1:1568 WOODBOURNE RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19057-1508
Mailing Address - Country:US
Mailing Address - Phone:215-943-7800
Mailing Address - Fax:215-943-5799
Practice Address - Street 1:1568 WOODBOURNE RD
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19057-1508
Practice Address - Country:US
Practice Address - Phone:215-943-7800
Practice Address - Fax:215-943-5799
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000874152W00000X
NJ27OA00559900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7915705Medicaid
PA01748393-01Medicaid
PA033728FMMMedicare ID - Type UnspecifiedPA INDIVIDUAL MEDICARE
PA01748393-01Medicaid
U74847Medicare UPIN