Active NPI
Steven Burdette Nicholson, O.D.
- Optometrist
- Hastings, NE
National Provider Identifier
1497861629
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 830
- Practice address
- 1414 W 12TH St
Hastings, NE 68901-3742 - Phone
- (402) 462-9191
- NPI assigned
- Aug 21, 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 | 830 | NE | Primary |
Addresses
Primary practice location
1414 W 12TH St
Hastings, NE 68901-3742
Mailing address
1414 W 12TH St
Hastings, NE 68901-3742
Phone (402) 462-9191
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100249873-00 | Medicaid | NE |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 830 | NE | MD | Occupational Therapist |
| 618 | NE | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1394755200000",
"number": "1497861629",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1414 W 12TH ST",
"city": "HASTINGS",
"state": "NE",
"postal_code": "689013742",
"telephone_number": "402-462-9191"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1414 W 12TH ST",
"city": "HASTINGS",
"state": "NE",
"postal_code": "689013742",
"telephone_number": "402-462-9191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLSON",
"first_name": "STEVEN",
"middle_name": "BURDETTE",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-21",
"last_updated": "2014-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NE",
"license": "830",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100249873-00",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hastings, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.