Provider Demographics
NPI:1982808937
Name:NICOLAU, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:NICOLAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:2191 NW MILITARY HWY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1836
Mailing Address - Country:US
Mailing Address - Phone:210-348-8788
Mailing Address - Fax:210-348-8768
Practice Address - Street 1:1100 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4712
Practice Address - Country:US
Practice Address - Phone:210-222-2154
Practice Address - Fax:210-227-6056
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6803207WX0108X, 207W00000X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0108XAllopathic & Osteopathic PhysiciansOphthalmologyUveitis and Ocular Inflammatory Disease
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1906315-06Medicaid
TX190631507Medicaid
TX524821ZWBDMedicare PIN
TXTXB108998Medicare PIN