Provider Demographics
NPI:1639771298
Name:NIETO, NICKOLE (COT)
Entity Type:Individual
Prefix:MRS
First Name:NICKOLE
Middle Name:
Last Name:NIETO
Suffix:
Gender:F
Credentials:COT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1562 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-3636
Mailing Address - Country:US
Mailing Address - Phone:720-436-6262
Mailing Address - Fax:
Practice Address - Street 1:1562 CHERRY ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-3636
Practice Address - Country:US
Practice Address - Phone:720-436-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO281683156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic