Individual
STACIE R. NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
506 8TH ST., DAVENPORT, WA 99122
(509) 725-2000
(509) 725-4231
Mailing address
PO BOX 27, DAVENPORT, WA 99122-0027
(509) 725-2000
(509) 725-4231
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD00003248
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2025815
—
WA
Enumeration date
07/19/2006
Last updated
04/01/2010
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