Provider Demographics
NPI:1932366655
Name:NICHOLE Q SOTO OD PC
Entity Type:Organization
Organization Name:NICHOLE Q SOTO OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:Q
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:361-729-2020
Mailing Address - Street 1:2740 HIGHWAY 35 N
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-5709
Mailing Address - Country:US
Mailing Address - Phone:361-729-2020
Mailing Address - Fax:361-729-4525
Practice Address - Street 1:2740 HIGHWAY 35 N
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-5709
Practice Address - Country:US
Practice Address - Phone:361-729-2020
Practice Address - Fax:361-729-4525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4476290001Medicare NSC