| Organization Name: | GARY NICKEL, OD, PA |
| NPI Number: | 1538309620 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GARY P NICKEL (OPTOMTRIST) |
| Mailing Address: | 404 N 14th St Independence |
| State: | KS US |
| Postal Code: | 673012909 |
| Phone Number: | 6203310910 |
| Fax Number: | 6203312121 |
| NPI Enumeration Date: | 03/02/2009 |
| NPI Last Update Date: | 03/03/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 09562 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |