Kelly K. Nichols, OD, MPH, PHD

Primary specialty

OptometristTaxonomy code 152W00000X

License

R-222-TA-976 Issued in AL

Practice address

1716 University Blvd
HPB G080A
Birmingham, AL 35294-0010

Phone

(205) 975-2020

Fax

(205) 934-6755

NPI assigned

Apr 25, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406160000000",
    "number": "1558327817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1716 UNIVERSITY BLVD",
            "address_2": "HPB G080A",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352940010",
            "telephone_number": "205-975-2020",
            "fax_number": "205-934-6755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1716 UNIVERSITY BLVD",
            "address_2": "HPB G080A",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352940010",
            "telephone_number": "205-975-2020",
            "fax_number": "205-934-6755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "KELLY",
        "middle_name": "K.",
        "name_prefix": "Dr.",
        "credential": "OD, MPH, PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-25",
        "last_updated": "2014-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AL",
            "license": "T-215-TA-976",
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "OH",
            "license": "4722/T1517",
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "TX",
            "license": "7914TG",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AL",
            "license": "R-222-TA-976",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112409104",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Lurie Nichols, MD
• Emily Morgan Nichols
• Hartley Elise Nichols, O.D.
• John Charles Nichols
• John Thomas Nichols, CRNP
• Michael Nichols
• Michele Holloway Nichols, MD
• Stephanie Nichols
• Jeffrey K Nicholson, MD
• Niesha Nicholson

• Optometrist in Birmingham, AL
• Providers in Birmingham, AL by specialty
• Optometrist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 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.

Verify at the official NPI Registry.