Individual
DR. LARRY LEE NICHOLSON II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
19870 MAIN E ST, HUNTINGDON, TN 38344-3927
(731) 986-4400
(731) 986-7981
Mailing address
19870 MAIN E ST, HUNTINGDON, TN 38344-3927
(731) 986-4400
(731) 986-7981
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODT2544
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0381350001
DMERC #
TN
01
—
32920
MEMPHIS MGED CARE- TLC
TN
05
—
3946177
—
TN
01
—
4086613
BCBS
TN
01
—
621149225SCA1
HEALTH PARTNERS
TN
01
—
P00137806
RAILROAD MEDICARE
TN
Enumeration date
06/01/2005
Last updated
03/07/2023
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