Active NPI
David S Nichols, M.D.
- Ophthalmology Physician
- Brandon, FL
National Provider Identifier
1154328920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- ME0043731
- Practice address
- 403 Vonderburg Dr
Ste 101
Brandon, FL 33511-5982 - Phone
- (813) 681-1122
- Fax
- (813) 684-4924
- NPI assigned
- Jul 7, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | ME0043731 | FL | Primary |
Addresses
Primary practice location
403 Vonderburg Dr
Ste 101
Brandon, FL 33511-5982
Mailing address
403 Vonderburg Dr
Ste 101
Brandon, FL 33511-5982
Phone (813) 681-1122
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0049901 | Other | NY | GHI |
| 4091614 | Other | FL | AETNA |
| 0805216 | Other | FL | UNITED HEALTHCARE |
| 30744 | Other | FL | BCBS FLORIDA |
| 2074201 | Other | FL | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME0043731 | FL | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473206400000",
"number": "1154328920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "403 VONDERBURG DR",
"address_2": "STE 101",
"city": "BRANDON",
"state": "FL",
"postal_code": "335115982",
"telephone_number": "813-681-1122",
"fax_number": "813-684-4924"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "403 VONDERBURG DR",
"address_2": "STE 101",
"city": "BRANDON",
"state": "FL",
"postal_code": "335115982",
"telephone_number": "813-681-1122",
"fax_number": "813-684-4924"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "DAVID",
"middle_name": "S",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-07",
"last_updated": "2016-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "FL",
"license": "ME0043731",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "0049901",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4091614",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "0805216",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS FLORIDA",
"identifier": "30744",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "2074201",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brandon, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.