Provider Demographics
NPI:1689920480
Name:WAINWRIGHT, NICOLE J (OD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:J
Last Name:WAINWRIGHT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:J
Other - Last Name:TRABUC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:631 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WAMEGO
Mailing Address - State:KS
Mailing Address - Zip Code:66547-1635
Mailing Address - Country:US
Mailing Address - Phone:785-456-2236
Mailing Address - Fax:785-456-2570
Practice Address - Street 1:631 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547
Practice Address - Country:US
Practice Address - Phone:785-456-2236
Practice Address - Fax:785-456-2570
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1930152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist