Organization
DR. J PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSHUA ERIC NICHOLS OD (OWNER/OPTOMETRIST)
(606) 340-9541
Entity
Organization
Contact information
Practice address
1461 E HIGHWAY 90 BYP, MONTICELLO, KY 42633-2327
(606) 340-9541
(606) 677-6542
Mailing address
611 RIDGEWOOD AVE, MONTICELLO, KY 42633-1761
(606) 340-9541
(606) 677-6542
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1552DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77903680
—
KY
Enumeration date
08/20/2006
Last updated
08/22/2020
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