Provider Demographics
NPI:1053758334
Name:FEIPEL, NICHOLAS CHALMER (OD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:CHALMER
Last Name:FEIPEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16409 SOUTHPARK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8470
Mailing Address - Country:US
Mailing Address - Phone:317-896-5005
Mailing Address - Fax:
Practice Address - Street 1:16409 SOUTHPARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8470
Practice Address - Country:US
Practice Address - Phone:317-896-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003777A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN18003777AOtherOPTOMETRIST LICENSE