Provider Demographics
NPI:1407914963
Name:LOUIS H NICOLAUS OPTICAL COMPANY
Entity Type:Organization
Organization Name:LOUIS H NICOLAUS OPTICAL COMPANY
Other - Org Name:NICOLAUS OPTICAL COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:N
Authorized Official - Last Name:BAZLEN
Authorized Official - Suffix:
Authorized Official - Credentials:RDO
Authorized Official - Phone:916-483-5086
Mailing Address - Street 1:3301 ARDEN WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2016
Mailing Address - Country:US
Mailing Address - Phone:916-483-5086
Mailing Address - Fax:916-483-5088
Practice Address - Street 1:3301 ARDEN WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2016
Practice Address - Country:US
Practice Address - Phone:916-483-5086
Practice Address - Fax:916-483-5088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ3320ZMedicaid
CA0530180001Medicare ID - Type Unspecified