Cruz, Nichole M.
Cruz, Nichole M. is an sole proprietor health care provider with primary practice located at 675 Wolf Rd , Random Lake WI 53075-1264. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Cruz, Nichole M. can be contacted via phone (920) 994-8500.Contact Information
Primary practice address
675 Wolf Rd
Random Lake WI 53075-1264
Phone: (920) 994-8500
Fax: (920) 994-8550
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 2823-035 | Wisconsin |
Profile Details
| NPI number | 1801906102 |
|---|---|
| LBN Legal business name | Cruz, Nichole M. |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 30th, 2006 |
| Last updated | May 19th, 2014 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1801906102 | NPPES |
| Wisconsin | MEDICAID | 38623000 |
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