Active NPI
Michael L Nichols, O.D.
- Optometrist
- Columbia, MO
National Provider Identifier
1356301352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- T02342
- Practice address
- 500 Keene St
Suite 103
Columbia, MO 65201-8104 - Phone
- (573) 874-2030
- Fax
- (573) 449-0253
- NPI assigned
- Mar 24, 2006
- 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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | T02342 | MO | Primary |
Addresses
Primary practice location
500 Keene St
Suite 103
Columbia, MO 65201-8104
Mailing address
500 Keene St
Suite 103
Columbia, MO 65201-8104
Phone (573) 874-2030
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0270770001 | Other | MO | NORIDIAN-DMERC |
| 108175 | Other | MO | BC/BS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Columbia Eyewear | Past | Accepting new patients |
Interoperability endpoints
- michael.nichols@direct.revolutionehr.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Optician
- Columbia, MO
- NPI 1720134513
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193875200000",
"number": "1356301352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 KEENE ST",
"address_2": "SUITE 103",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652018104",
"telephone_number": "573-874-2030",
"fax_number": "573-449-0253"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 KEENE ST",
"address_2": "SUITE 103",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652018104",
"telephone_number": "573-874-2030",
"fax_number": "573-449-0253"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "MICHAEL",
"middle_name": "L",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-24",
"last_updated": "2007-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MO",
"license": "T02342",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NORIDIAN-DMERC",
"identifier": "0270770001",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "108175",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2007; 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.