Provider Demographics
NPI:1336365287
Name:MIKE NICHOLAS, O.D. INC.
Entity Type:Organization
Organization Name:MIKE NICHOLAS, O.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:T
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:NICHOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-242-3273
Mailing Address - Street 1:1215 W YORK AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-7106
Mailing Address - Country:US
Mailing Address - Phone:580-242-3273
Mailing Address - Fax:
Practice Address - Street 1:1215 W YORK AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-7106
Practice Address - Country:US
Practice Address - Phone:580-242-3273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK848152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty