Provider Demographics
NPI:1023633278
Name:DEMARCO, NICOLE BROOKE (OD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:BROOKE
Last Name:DEMARCO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 783
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-0783
Mailing Address - Country:US
Mailing Address - Phone:509-689-2342
Mailing Address - Fax:509-689-9207
Practice Address - Street 1:123 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:WA
Practice Address - Zip Code:98812-0015
Practice Address - Country:US
Practice Address - Phone:509-689-2342
Practice Address - Fax:509-689-9207
Is Sole Proprietor?:No
Enumeration Date:2020-06-13
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOPD-100507152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist