Provider Demographics
NPI:1962440784
Name:NICHOLS, JOSHUA ERIC (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:ERIC
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 PARKER'S MILL WAY
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503
Mailing Address - Country:US
Mailing Address - Phone:606-677-0377
Mailing Address - Fax:606-677-6542
Practice Address - Street 1:165 PARKER'S MILL WAY
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503
Practice Address - Country:US
Practice Address - Phone:606-677-0377
Practice Address - Fax:606-677-6542
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1552DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77000677Medicaid
KY77000677Medicaid
KYU91611Medicare UPIN