Individual
DR. KELLY K. NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD, MPH, PHD
Contact information
Practice address
1716 UNIVERSITY BLVD, HPB G080A, BIRMINGHAM, AL 35294-0010
(205) 975-2020
(205) 934-6755
Mailing address
1716 UNIVERSITY BLVD, HPB G080A, BIRMINGHAM, AL 35294-0010
(205) 975-2020
(205) 934-6755
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
R-222-TA-976
AL
152W00000X
Optometrist
T-215-TA-976
AL
152WC0802X
Corneal and Contact Management Optometrist
4722/T1517
OH
152WC0802X
Corneal and Contact Management Optometrist
7914TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112409104
—
TX
Enumeration date
04/25/2006
Last updated
07/24/2014
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