Provider Demographics
NPI:1184622235
Name:NICHOLAS, THOMAS M II (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:NICHOLAS
Suffix:II
Gender:M
Credentials:OD
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Mailing Address - Street 1:1204 W WILLOW RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-2531
Mailing Address - Country:US
Mailing Address - Phone:580-234-2333
Mailing Address - Fax:580-234-0820
Practice Address - Street 1:1204 W WILLOW RD
Practice Address - Street 2:SUITE A
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-2531
Practice Address - Country:US
Practice Address - Phone:580-234-2333
Practice Address - Fax:580-234-0820
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK2256152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU71556Medicare UPIN