Provider Demographics
NPI:1508845256
Name:NICHOLS, TIMOTHY C (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:C
Last Name:NICHOLS
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 1:418 MARTLING RD
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35951-7208
Mailing Address - Country:US
Mailing Address - Phone:256-878-4201
Mailing Address - Fax:256-891-1908
Practice Address - Street 1:418 MARTLING RD
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35951-7208
Practice Address - Country:US
Practice Address - Phone:256-878-4201
Practice Address - Fax:256-891-1908
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS482TA067152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T69010Medicare UPIN
AL0133560001Medicare NSC
AL51079206NICMedicare ID - Type Unspecified