Provider Demographics
NPI:1902368939
Name:CHANEY, NICOLE DAWN (OD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:DAWN
Last Name:CHANEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:DAWN
Other - Last Name:CHARRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:18 HOLLEY CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-8578
Mailing Address - Country:US
Mailing Address - Phone:405-420-4336
Mailing Address - Fax:
Practice Address - Street 1:1124 KEMPER MEADOW DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-4117
Practice Address - Country:US
Practice Address - Phone:513-851-2414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-31
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2968152W00000X
OHOPT.006810152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist