| Doctor Name: | DR. PHILIP LEROY NICHOLSON |
| NPI Number: | 1184813974 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | O.D. |
| License Number: | TA1322 |
| Business Practice Address: | 10925 Baltimore Ave Optical Department Beltsville, MD - 207052117 |
| Business Phone Number: | 3015959041 |
| Business Fax Number: | |
| Mailing Address: | 17904 Georgia Ave, Suite 203 OLNEY |
| State: | MD |
| Postal Code: | 208322239 |
| Phone Number: | 3015959041 |
| Fax Number: | |
| NPI Enumeration Date: | 10/17/2007 |
| NPI Last Update Date: | 10/17/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 152WV0400X |
| License Number: | TA1322 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MD |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Optometrist |
| Taxonomy Specialization: | Vision Therapy |
| Taxonomy Definition: | Optometrists who specialize in vision therapy as a treatment process used to improve vision function. It includes a broad range of developmental and rehabilitative treatment programs individually prescribed to remediate specific sensory, motor and/or visual perceptual dysfunctions. |