Individual
NICOLE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
2580 N LITCHFIELD RD, GOODYEAR, AZ 85395-2049
(623) 932-2020
(623) 932-2668
Mailing address
2580 N LITCHFIELD RD, GOODYEAR, AZ 85395-2049
(623) 932-2020
(623) 932-2668
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2177
AZ
152W00000X
Optometrist
8753T
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00E63G
MEDICARE
TX
Enumeration date
07/01/2015
Last updated
07/21/2022
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