Provider Demographics
NPI:1518955749
Name:NELL, RHONDA (OD)
Entity Type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:
Last Name:NELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:RHONDA
Other - Middle Name:
Other - Last Name:WICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:220 N MCKEMY AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2654
Mailing Address - Country:US
Mailing Address - Phone:480-961-1865
Mailing Address - Fax:480-961-4605
Practice Address - Street 1:220 N MCKEMY AVE
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-2654
Practice Address - Country:US
Practice Address - Phone:480-961-1865
Practice Address - Fax:480-961-4605
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1199152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ163939Medicare PIN
AZZ163937Medicare PIN
AZZ162075Medicare PIN
AZZ162076Medicare PIN
AZZ162078Medicare PIN
AZZ163938Medicare PIN
AZZ162079Medicare PIN
AZZ162077Medicare PIN
AZZ76700Medicare PIN
AZZ163940Medicare PIN
AZZ163942Medicare PIN
AZU02635Medicare UPIN
AZZ163941Medicare PIN
AZZ162074Medicare PIN