Provider Demographics
NPI:1356725592
Name:NIEVES, ERICA NICOLE (OD)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:NICOLE
Last Name:NIEVES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1142 WILDE DR
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4046
Mailing Address - Country:US
Mailing Address - Phone:407-922-5870
Mailing Address - Fax:
Practice Address - Street 1:550 US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714
Practice Address - Country:US
Practice Address - Phone:407-666-0828
Practice Address - Fax:866-838-6099
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5087152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist