Provider Demographics
NPI:1346293792
Name:NICOLAI, THOMAS J (OD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:NICOLAI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:305 ELAINES CT
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-2103
Mailing Address - Country:US
Mailing Address - Phone:608-930-4362
Mailing Address - Fax:608-930-4366
Practice Address - Street 1:305 ELAINES CT
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-2103
Practice Address - Country:US
Practice Address - Phone:608-930-4362
Practice Address - Fax:608-930-4366
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2383-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1346293792Medicaid
WIK400177031Medicare PIN
WI1346293792Medicaid
T98257Medicare UPIN
WI38580300Medicaid
WI1024096OtherPHYSICIANS PLUS