Katherine Dawn Nickerson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT966 Issued in ME

Practice address

35 State Hospital Dr
Bangor, ME 04401-8816

Phone

(207) 561-3600

NPI assigned

Jul 28, 2015

Sex

Female

Sole proprietor

No

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 ME

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

New England College of Optometry, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Caribou Eyecare, P.a.Group PAC ID 4284642539, 3 clinicians

Casco Bay Eyecare LLCGroup PAC ID 3274620562, 8 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

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.

• Caribou Eyecare, P.a.

  • Optometrist
  • Caribou, ME
  • NPI 1356470645
  Medicare reassignment Care Compare group NPD
• Casco Bay Eyecare LLC

  • Optometrist
  • South Portland, ME
  • NPI 1063401693
  Medicare reassignment Care Compare group NPD
• Casco Bay Eye Care LLC

  • Eyewear Supplier
  • Portland, ME
  • NPI 1508931361
  NPD (past)

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

{
    "created_epoch": "1438041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444003200000",
    "number": "1881079192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 STATE HOSPITAL DR",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044018816",
            "telephone_number": "207-561-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 STATE HOSPITAL DR",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044018816",
            "telephone_number": "207-561-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKERSON",
        "first_name": "KATHERINE",
        "middle_name": "DAWN",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-28",
        "last_updated": "2015-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ME",
            "license": "OPT966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edward P. Nicholas, M.D.
• Karolyn Nicholas, MD
• Karen E. Nichols, PA-C
• Brandi Lyon Nickerson, PA-C
• Denise Marie Nickerson, LCSW
• Meisha B Nickerson, LCSW
• John Nicolet, MD
• Heidi L Niles, DPT
• Joyce E Niles, NP
• Sigrid Noack, MD

• Optometrist in Bangor, ME
• Providers in Bangor, ME by specialty
• Optometrist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2015; 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.