Healthcare Provider Details

I. General information

NPI: 1508184748
Provider Name (Legal Business Name): NASH ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N COURT ST
MEDINA OH
44256-1749
US

IV. Provider business mailing address

707 N COURT ST
MEDINA OH
44256-1749
US

V. Phone/Fax

Practice location:
  • Phone: 330-725-3937
  • Fax:
Mailing address:
  • Phone: 330-725-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberSC3483
License Number StateOH

VIII. Authorized Official

Name: MR. BRIAN SCOTT NASH I
Title or Position: OPTICIAN
Credential: L.D.O.
Phone: 330-725-3937