Provider Demographics
NPI:1578659876
Name:MEADOWS, NIKKI S (OD)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:S
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:L
Other - Last Name:SARTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2002 MEDICAL PARKWAY
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:410-571-8733
Mailing Address - Fax:410-571-6309
Practice Address - Street 1:2002 MEDICAL PARKWAY
Practice Address - Street 2:SUITE 320
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-571-8733
Practice Address - Fax:410-571-6309
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1731152W00000X
VA0618001469152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist