Provider Demographics
NPI:1487604898
Name:MAYFIELD, NICOL L (OD)
Entity type:Individual
Prefix:MS
First Name:NICOL
Middle Name:L
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:NICOL
Other - Middle Name:L
Other - Last Name:MATUSIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1233 BLUE SKY LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8158
Mailing Address - Country:US
Mailing Address - Phone:402-312-6319
Mailing Address - Fax:607-257-3972
Practice Address - Street 1:110 NNPTC CIR
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-6314
Practice Address - Country:US
Practice Address - Phone:843-794-6881
Practice Address - Fax:843-794-6041
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2148152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSCH673J061OtherMEDICARE PTAN
NE10025806600Medicaid
NE10025806600Medicaid