Provider Demographics
NPI:1578502258
Name:EYE HEALTH SPECIALISTS II, PLLC
Entity Type:Organization
Organization Name:EYE HEALTH SPECIALISTS II, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:E
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:606-365-3220
Mailing Address - Street 1:713 E MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:KY
Mailing Address - Zip Code:40484
Mailing Address - Country:US
Mailing Address - Phone:606-365-3220
Mailing Address - Fax:606-365-3166
Practice Address - Street 1:713 E MAIN ST
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:KY
Practice Address - Zip Code:40484-1404
Practice Address - Country:US
Practice Address - Phone:606-365-3220
Practice Address - Fax:606-365-3166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1544DT152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77904068Medicaid
KY77904068Medicaid
KYU91610Medicare UPIN
KY5809050001Medicare NSC