Organization
COLUMBIA EYEWEAR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL L NICHOLS OD (PARTNER)
(573) 874-2030
Entity
Organization
Contact information
Practice address
500 KEENE STREET, SUITE 103, COLUMBIA, MO 65201
(573) 874-2030
Mailing address
500 KEENE ST, SUITE 103, COLUMBIA, MO 65201-8104
(573) 874-2030
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107546
BLUE CROSS
MO
Enumeration date
01/26/2007
Last updated
11/01/2007
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