Basic Information
| Provider Information | |||||||||
| NPI: | 1639430564 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCALES | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 W EXCHANGE ST | ||||||||
| Address2: | |||||||||
| City: | SPRING LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494562024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6168420620 | ||||||||
| FaxNumber: | 6168446079 | ||||||||
| Practice Location | |||||||||
| Address1: | 314 W SAVIDGE ST | ||||||||
| Address2: | |||||||||
| City: | SPRING LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494561607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6168447000 | ||||||||
| FaxNumber: | 6168446079 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2012 | ||||||||
| LastUpdateDate: | 11/04/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 4901004697 | MI | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.