Nicolette M Evans, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT006950 Issued in OH

Practice address

1025 Grand Lake Rd
Celina, OH 45822-1309

Phone

(419) 235-2059

Fax

(419) 586-1059

NPI assigned

Jun 15, 2021

Last updated

Jun 16, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nicollete.evans@direct.revolutionehr.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Grand Lake Eyecare LLC

  • Optometrist
  • Celina, OH
  • NPI 1548301690
  Medicare reassignment NPD
• Grand Lake Eyecare, LLC

  • Optometrist
  • Fort Recovery, OH
  • NPI 1487083697
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623801600000",
    "number": "1043888035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 GRAND LAKE RD",
            "city": "CELINA",
            "state": "OH",
            "postal_code": "458221309",
            "telephone_number": "419-235-2059",
            "fax_number": "419-586-1059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 GRAND LAKE RD",
            "city": "CELINA",
            "state": "OH",
            "postal_code": "458221309",
            "telephone_number": "419-235-2059",
            "fax_number": "419-586-1059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "NICOLETTE",
        "middle_name": "M",
        "name_prefix": "Miss",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-15",
        "last_updated": "2021-06-16",
        "certification_date": "2021-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "OPT006950",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alyssa Evans, RN
• Diane Evans
• Lagaya S Evans
• Madison G Evans
• McKenna Faith Evans
• Family Audiology Associates, Inc.
• Family Audiology Associates, Inc.
• Family Care Options Inc
• Erica Marie Feison, PA-C
• Valerie R Fetters

• Optometrist in Celina, OH
• Providers in Celina, OH by specialty
• Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.