Larry Lee Nicholson II OD

Key facts

NPI

1477595783

Entity type

Organization (NPI type 2)

Primary specialty

Optometrist 152W00000X

Legal business name

LARRY LEE NICHOLSON II OD

Practice address

19870 Main St E
Huntingdon, TN 38344-3927

Phone

(731) 986-4400

Fax

(731) 986-7981

NPI assigned

Jun 12, 2006

Organization subpart

No

Authorized official

Name

Larry Lee Nicholson II OD, O.D.

Title

Owner Corporation President

Phone

(731) 986-4400

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Larry Lee Nicholson II, O.D. Optometrist · Huntingdon, TN · NPI 1053313338
  Medicare reassignment TN

Medicare participation

Medicare fee-for-service enrollment

Enrolled in TN

Medicare enrollment records

National Provider Directory

Specialties & licenses

Addresses

Other identifiers

Other names

• Huntingdon Eye Care, PC Other name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 2, 2013.

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380672000000",
    "number": "1477595783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19870 MAIN ST E",
            "city": "HUNTINGDON",
            "state": "TN",
            "postal_code": "383443927",
            "telephone_number": "731-986-4400",
            "fax_number": "731-986-7981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19870 MAIN ST E",
            "city": "HUNTINGDON",
            "state": "TN",
            "postal_code": "383443927",
            "telephone_number": "731-986-4400",
            "fax_number": "731-986-7981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARRY LEE NICHOLSON II OD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2013-10-02",
        "status": "A",
        "authorized_official_last_name": "NICHOLSON II OD",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER CORPORATION PRESIDENT",
        "authorized_official_telephone_number": "731-986-4400",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DB9347",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INDIVIUAL",
            "identifier": "3946177",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Huntingdon Eye Care, PC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Huntingdon, TN

• Amber Kee, PTA
• Kathy G Kee, NP,RN,BSN
• Misty McRae King, P.T.
• Jill Marie Kirk, RN
• Jantzen Kirra Lambert, D.D.S.
• Lee Marvin Carter
• Malarie Brooke Leonard, PHARM.D.
• LHCG Xciv, LLC
• LHCG Xcvi, LLC
• Shearll Denece Lockhart, LPN

All providers in Huntingdon, TN · Optometrist in Tennessee