Provider Demographics
NPI:1689444986
Name:NICOLE RIST COLLINS, OD, PLLC
Entity Type:Organization
Organization Name:NICOLE RIST COLLINS, OD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:RIST
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-553-2020
Mailing Address - Street 1:1433 EMERYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-4105
Mailing Address - Country:US
Mailing Address - Phone:704-553-2020
Mailing Address - Fax:980-299-2150
Practice Address - Street 1:1433 EMERYWOOD DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-4105
Practice Address - Country:US
Practice Address - Phone:704-553-2020
Practice Address - Fax:980-299-2150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty