Individual
MRS. CHELLE NICKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
57 N MAIN ST, FARMINGTON, UT 84025-3517
(801) 447-4393
Mailing address
112 N 1000 W, KAYSVILLE, UT 84037-2485
(801) 444-7124
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
375826-9934
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
375826-8908
UTAH OD CONTROLLED SUBSTA
UT
01
—
375826-9934
UTAH OPTOMETRIST LICENSE
UT
Enumeration date
10/23/2006
Last updated
02/23/2010
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