Healthcare Provider Details

I. General information

NPI: 1902808025
Provider Name (Legal Business Name): NIX OPTICAL COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 LINCOLN AVENUE EXT
CHARLEROI PA
15022-3080
US

IV. Provider business mailing address

PO BOX 6 216 LINCOLN AVENUE EXT
CHARLEROI PA
15022-0006
US

V. Phone/Fax

Practice location:
  • Phone: 724-483-6527
  • Fax: 724-483-6504
Mailing address:
  • Phone: 724-483-6527
  • Fax: 724-483-6504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY LEE NIX
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 724-483-6527