Provider Demographics
NPI:1336695220
Name:SWEENEY, NICHOLAS (OD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:SWEENEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 RIDDELL ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-2025
Mailing Address - Country:US
Mailing Address - Phone:413-774-7016
Mailing Address - Fax:
Practice Address - Street 1:3586 ARAMINGO AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4606
Practice Address - Country:US
Practice Address - Phone:215-535-4264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2019-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5161152W00000X
PAOEG003534152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist