Organization Active NPI

Nicholas Eye Clinic, PLLC

  • Optometrist
  • Enid, OK
National Provider Identifier
1487789913
Registry record updated Feb 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
NICHOLAS EYE CLINIC, PLLC
Practice address
1204 W Willow Rd
Suite a
Enid, OK 73703-2531
Phone
(580) 234-2333
Fax
(580) 234-0820
NPI assigned
Feb 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2010

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

Authorized official

Name
Valarie Nicholas
Title
Office Manager
Phone
(580) 234-2333

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

1204 W Willow Rd
Suite a
Enid, OK 73703-2531

Mailing address

1204 W Willow Rd
Suite a
Enid, OK 73703-2531
Phone (580) 234-2333

Other identifiers 1

IdentifierTypeStateIssuer
410044611OtherOKRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050415000699 OK Part B Supplier - Clinic/Group Practice 5092752402 Receives reassigned benefits from 2 practitioners
Practice locations: Enid, OK
O20100930097329 OK DME Supplier - Physician - Optometrist 5092752402 Practice locations: Enid, OK

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Nicholas Eye Clinic, PLLC1204 W Willow Rd, Enid, OK 73703-2531(580) 234-2333 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jan 1, 2000

National Provider Directory

National Provider Directory

Locations

1204 W Willow Rd
Enid, OK 73703

1204 W Willow Rd
Ste A
Enid, OK 73703
Phone (580) 234-2333

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265241600000",
    "number": "1487789913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1204 W WILLOW RD",
            "address_2": "SUITE A",
            "city": "ENID",
            "state": "OK",
            "postal_code": "737032531",
            "telephone_number": "580-234-2333",
            "fax_number": "580-234-0820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 W WILLOW RD",
            "address_2": "SUITE A",
            "city": "ENID",
            "state": "OK",
            "postal_code": "737032531",
            "telephone_number": "580-234-2333",
            "fax_number": "580-234-0820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICHOLAS EYE CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "last_updated": "2010-02-04",
        "status": "A",
        "authorized_official_last_name": "NICHOLAS",
        "authorized_official_first_name": "VALARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "580-234-2333"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "410044611",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Enid, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.