Provider Demographics
NPI:1639444326
Name:KEITH B. NICE, OD, PLLC
Entity Type:Organization
Organization Name:KEITH B. NICE, OD, PLLC
Other - Org Name:NICE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:BYRON
Authorized Official - Last Name:NICE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-228-1766
Mailing Address - Street 1:2603 HOLLY HILL ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5156
Mailing Address - Country:US
Mailing Address - Phone:336-228-1766
Mailing Address - Fax:336-228-6432
Practice Address - Street 1:2603 HOLLY HILL ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5156
Practice Address - Country:US
Practice Address - Phone:336-228-1766
Practice Address - Fax:336-228-6432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
NC200001781381332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909429Medicaid
NC8909429Medicaid