Active NPI
Aubrey Norwood Nichols III, M.D.
- Ophthalmology Physician
- McComb, MS
National Provider Identifier
1730239229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 07694
- Practice address
- 414B Marion Ave
McComb, MS 39648-2710 - Phone
- (601) 684-3112
- Fax
- (601) 249-3290
- NPI assigned
- Jan 10, 2007
- Sex
- Male
- Sole proprietor
- No
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.
-
- Ambulatory Surgical Clinic/Center
- McComb, MS
- NPI 1902957483
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
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eye and Aesthetic Surgery Center, LLC | Past | Accepting new patients |
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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 07694 | MS | Primary |
Addresses
Primary practice location
414B Marion Ave
McComb, MS 39648-2710
Mailing address
414B Marion Ave
McComb, MS 39648-2710
Phone (601) 684-3112
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5875836375A | Other | MS | BLUE CROSS BLUE SHIELD - ALL |
| 07694 | Other | MS | STATE LICENSE |
| 00119350 | Medicaid | MS | |
| 1346385762 | Other | CIGNA |
NPI Registry JSON
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294963200000",
"number": "1730239229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "414B MARION AVE",
"city": "MCCOMB",
"state": "MS",
"postal_code": "396482710",
"telephone_number": "601-684-3112",
"fax_number": "601-249-3290"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "414B MARION AVE",
"city": "MCCOMB",
"state": "MS",
"postal_code": "396482710",
"telephone_number": "601-684-3112",
"fax_number": "601-249-3290"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "AUBREY",
"middle_name": "NORWOOD",
"name_suffix": "III",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-10",
"last_updated": "2011-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "MS",
"license": "07694",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD - ALL",
"identifier": "5875836375A",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "07694",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00119350",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "1346385762",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in McComb, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.