Organization
PANOPTIC PMR LLC
Active
Organization
PANOPTIC PMR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER TODD NICHOLS MD (MD/OWNER)
(251) 377-5228
Entity
Organization
Contact information
Practice address
8088 HAWKS RD, LEESVILLE, LA 71446-6649
(251) 377-5228
Mailing address
711 7TH ST, LAKE CHARLES, LA 70601-6274
(251) 377-5228
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1485250
—
LA
01
—
1508482241
BCBS
LA
01
—
311032
LA STATE BOARD OF MEDICAL EXAMINERS
LA
Enumeration date
06/18/2020
Last updated
03/04/2021
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