Basic Information
| Provider Information | |||||||||
| NPI: | 1366418790 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NICHOLS | ||||||||
| FirstName: | CARTER | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7450 FRANCE AVE S | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554354787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528328100 | ||||||||
| FaxNumber: | 9528328176 | ||||||||
| Practice Location | |||||||||
| Address1: | 7450 FRANCE AVE S | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554354787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528328100 | ||||||||
| FaxNumber: | 9528328176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207W00000X | 34419 | MN | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 105073 | 01 | MN | PATIENT CHOICE | OTHER | 2F671NI | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER | 23387 | 01 | MN | AMERICA'S PPO/TPA | OTHER | 0800014 | 01 | MN | MEDICA DUEL SOLUTIONS | OTHER | 960560305008 | 01 | MN | PREFERRED ONE | OTHER | F21442 | 01 | MN | HEALTH PARTNERS | OTHER | 0824658 | 01 | MN | MEDICA | OTHER |