Healthcare Provider Details

I. General information

NPI: 1699525329
Provider Name (Legal Business Name): NATALIE NIEVES OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 SPRING VALLEY DR
HUNTINGTON WV
25704-9501
US

IV. Provider business mailing address

22718 HORSE SHOE WAY
BOCA RATON FL
33428-5505
US

V. Phone/Fax

Practice location:
  • Phone: 304-429-6741
  • Fax:
Mailing address:
  • Phone: 561-213-6805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number390200000X
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: