Basic Information
| Provider Information | |||||||||
| NPI: | 1902279318 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NICKELL AND STEELE OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 408 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WEST LIBERTY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 414721014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067454111 | ||||||||
| FaxNumber: | 6067432018 | ||||||||
| Practice Location | |||||||||
| Address1: | 408 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WEST LIBERTY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 414721014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067454111 | ||||||||
| FaxNumber: | 6067432018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2015 | ||||||||
| LastUpdateDate: | 01/06/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | NICKELL | ||||||||
| AuthorizedOfficialFirstName: | JOEL | ||||||||
| AuthorizedOfficialMiddleName: | KENT | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 6067434111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.