Basic Information
| Provider Information | |||||||||
| NPI: | 1902894579 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NICOSIA | ||||||||
| FirstName: | DANIELA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6501 E GREENWAY PKWY | ||||||||
| Address2: | STE 103-148 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852542065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024691834 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7071 N 138TH AVE | ||||||||
| Address2: | |||||||||
| City: | LUKE AFB | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235360332 | ||||||||
| FaxNumber: | 6235360332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2005 | ||||||||
| LastUpdateDate: | 04/22/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1030 | AZ | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.