Provider Demographics
NPI:1518065671
Name:NICHOLS, WESLEY GILMAN (OD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:GILMAN
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 1:197 MAIN ST.
Mailing Address - Street 2:P.O. BOX 530
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-0530
Mailing Address - Country:US
Mailing Address - Phone:603-526-4043
Mailing Address - Fax:603-526-6949
Practice Address - Street 1:197 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257-0530
Practice Address - Country:US
Practice Address - Phone:603-526-4043
Practice Address - Fax:603-526-6949
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH242152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80587769Medicaid
NHT25680Medicare UPIN
NH80587769Medicaid