Provider Demographics
NPI:1598136251
Name:EARLS, NICHOLAS (OD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:EARLS
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 1:1242 ART GALLERY RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-8198
Mailing Address - Country:US
Mailing Address - Phone:812-797-1746
Mailing Address - Fax:
Practice Address - Street 1:982 N MITTHOEFFER RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-2622
Practice Address - Country:US
Practice Address - Phone:317-898-2835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2009DT152W00000X
IN18004225152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty