Provider Demographics
NPI:1639681349
Name:VICKERS, NICHOLAS C
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:C
Last Name:VICKERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 B CHARLES DIMMOCK PKWY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834
Mailing Address - Country:US
Mailing Address - Phone:804-520-5105
Mailing Address - Fax:804-520-7745
Practice Address - Street 1:320 B CHARLES DIMMOCK PKWY
Practice Address - Street 2:SUITE 4
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834
Practice Address - Country:US
Practice Address - Phone:804-520-5105
Practice Address - Fax:804-520-7745
Is Sole Proprietor?:No
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101002226237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist