Provider Demographics
NPI:1508837584
Name:NICHOLSON, BRICE R (DO)
Entity Type:Individual
Prefix:DR
First Name:BRICE
Middle Name:R
Last Name:NICHOLSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BOONE RD
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312
Mailing Address - Country:US
Mailing Address - Phone:360-475-4295
Mailing Address - Fax:
Practice Address - Street 1:1 BOONE RD
Practice Address - Street 2:NAVAL HOSPITAL BREMERTON
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312
Practice Address - Country:US
Practice Address - Phone:360-475-4686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP 60251025207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology