Individual
THOMAS MICHAEL NICHOLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1204 W WILLOW RD, SUITE A, ENID, OK 73703-2531
(580) 234-2333
(580) 234-0820
Mailing address
1204 W WILLOW RD, SUITE A, ENID, OK 73703-2531
(580) 234-2333
(580) 234-0820
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
848
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
848
STATE LICENSE NUMER
OK
Enumeration date
10/11/2006
Last updated
12/29/2014
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