Provider Demographics
NPI:1609493824
Name:NICOLE KOHAN, O.D., INC.
Entity Type:Organization
Organization Name:NICOLE KOHAN, O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-328-4159
Mailing Address - Street 1:9798 FOOTHILL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3692
Mailing Address - Country:US
Mailing Address - Phone:714-328-4159
Mailing Address - Fax:
Practice Address - Street 1:944 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3757
Practice Address - Country:US
Practice Address - Phone:909-982-3040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty