Provider Demographics
NPI:1770659724
Name:NOYCE, NICCI R (OD)
Entity type:Individual
Prefix:MRS
First Name:NICCI
Middle Name:R
Last Name:NOYCE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8801 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-4062
Mailing Address - Country:US
Mailing Address - Phone:913-499-8404
Mailing Address - Fax:913-766-1430
Practice Address - Street 1:8801 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-4062
Practice Address - Country:US
Practice Address - Phone:913-499-8404
Practice Address - Fax:913-766-1430
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1613152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSR18C550Medicare PIN
KSR19C550Medicare PIN
KSR17C550Medicare PIN
U96252Medicare UPIN