Provider Demographics
NPI:1639430564
Name:SCALES, NICOLE B (OD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:B
Last Name:SCALES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:105 W EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-2024
Mailing Address - Country:US
Mailing Address - Phone:616-842-0620
Mailing Address - Fax:616-844-6079
Practice Address - Street 1:314 W SAVIDGE ST
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-1607
Practice Address - Country:US
Practice Address - Phone:616-844-7000
Practice Address - Fax:616-844-6079
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004697152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist