Provider Demographics
NPI:1053774489
Name:NICHOLS, ERIN ELIABETH (MD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:ELIABETH
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8140 NORTON PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6017
Mailing Address - Country:US
Mailing Address - Phone:440-255-1115
Mailing Address - Fax:440-255-1550
Practice Address - Street 1:8140 NORTON PKWY STE 110
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6017
Practice Address - Country:US
Practice Address - Phone:440-255-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-02
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.138536207W00000X
PAMT211265207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine