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DR. PHILIP LEROY NICHOLSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
10925 BALTIMORE AVE, OPTICAL DEPARTMENT, BELTSVILLE, MD 20705-2117
(301) 595-9041
Mailing address
17904 GEORGIA AVE, SUITE 203, OLNEY, MD 20832-2239
(301) 595-9041

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TA1322
MD
152WV0400X
Vision Therapy Optometrist
TA1322
MD

Other

Enumeration date
10/17/2007
Last updated
10/17/2007
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