Organization
GARY NICKEL, OD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY P NICKEL OD/PA (OPTOMTRIST)
(620) 331-0910
Entity
Organization
Contact information
Practice address
404 N 14TH ST, INDEPENDENCE, KS 67301-2909
(620) 331-0910
(620) 331-2121
Mailing address
PO BOX 474, INDEPENDENCE, KS 67301-0474
(620) 331-0910
(620) 331-2121
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
09562
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100090130B
—
KS
Enumeration date
03/02/2009
Last updated
03/03/2009
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