Provider Demographics
NPI:1780676486
Name:NICHOLS, HEATHER MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:MARIE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 UNIVERSITY RD # MS 7002
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93106-7880
Mailing Address - Country:US
Mailing Address - Phone:805-893-3170
Mailing Address - Fax:805-893-2952
Practice Address - Street 1:552 UNIVERSITY RD # MS 7002
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93106
Practice Address - Country:US
Practice Address - Phone:805-893-3170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11623T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA222489OtherLOCATION ID COLE
CA122280OtherDR. ID COLE
CA16290OtherMEDICAL EYE SERVICES
CASD0116230OtherMEDI-CAL
CA020725851OtherVSP
CA16290OtherMEDICAL EYE SERVICES
CASD0116230OtherMEDI-CAL