Provider Demographics
NPI:1053609693
Name:LILLIE, NICHOLAS VIJAY (OD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:VIJAY
Last Name:LILLIE
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:6101 LAKE MICHIGAN DR
Mailing Address - Street 2:STE B700
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-9215
Mailing Address - Country:US
Mailing Address - Phone:616-895-2020
Mailing Address - Fax:616-895-2060
Practice Address - Street 1:6101 LAKE MICHIGAN DR
Practice Address - Street 2:SUITE B 700
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-9215
Practice Address - Country:US
Practice Address - Phone:616-895-2020
Practice Address - Fax:616-895-2060
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2024-07-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4901004659152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist