Basic Information
| Provider Information | |||||||||
| NPI: | 1336695220 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SWEENEY | ||||||||
| FirstName: | NICHOLAS | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33 RIDDELL ST | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 013012025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137747016 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3586 ARAMINGO AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191344606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155354264 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2016 | ||||||||
| LastUpdateDate: | 09/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 5161 | MA | N | Eye and Vision Services Providers | Optometrist | 152W00000X | OEG003534 | PA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.