Organization
PROFESSIONAL EYECARE ASSOCIATES AND OPTICAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY LEE NICHOLSON II O.D. (OWNER/MANAGER)
(731) 415-9368
Entity
Organization
Contact information
Practice address
2118 E MAIN ST, HUMBOLDT, TN 38343-3054
(731) 784-1973
(731) 784-9545
Mailing address
2118 E MAIN ST, HUMBOLDT, TN 38343-3054
(731) 784-1973
(731) 784-9545
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODT2544
TN
Other
Enumeration date
01/25/2008
Last updated
05/25/2010
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