Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 256200 | NY |
NPI | 1023108115 |
---|---|
Provider Name | John C Nichols |
First Address | Fishkill, NY 12524-2264 |
Second Address | Fishkill, NY 12524-2264 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 09/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03197142 | (05) | NY |
H47783 | (02) |