Alisa Kourtney Nicholson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT002881 Issued in GA

Practice address

6700 Douglas Blvd Ste 1270
Douglasville, GA 30135

Phone

(770) 942-9827

NPI assigned

Sep 16, 2014

Last updated

Apr 30, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Infocus Eye Care, IncGroup PAC ID 0345594362, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Infocus Eye Care, Inc.

  dba Arbor Place Eye Care

  • Optometrist
  • Douglasville, GA
  • NPI 1023517471
  Medicare reassignment Care Compare group NPD Authorized official
• PMR Georgia Holding, LLC

  dba Jencare Neighborhood Medical Center

  • Specialist
  • Miami Gardens, FL
  • NPI 1609329630
  NPD (past)

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

{
    "created_epoch": "1410825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588204800000",
    "number": "1790186211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6700 DOUGLAS BLVD STE 1270",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301351590",
            "telephone_number": "770-942-9827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6700 DOUGLAS BLVD STE 1270",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "30135",
            "telephone_number": "770-942-9827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "ALISA",
        "middle_name": "KOURTNEY",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-09-16",
        "last_updated": "2020-04-30",
        "certification_date": "2020-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT002881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gifty N Nibo
• Nichols Center, Inc
• Nichols Counseling Services LLC
• Tara Elizabeth Nichols, MHC, LPC
• Tracy Nichols
• Nilo M. Nikain, DDS
• John Nino, MD
• Elizer Murangi Njeru, LPN
• Ebony Lettina Njie, MS
• Shenequa Anastasia Noel, LPN

• Optometrist in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.