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General NPI Number Information
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NPI Number | 1144487315
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Entity Type | Organization
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Legal Business Name | GARY NESTY
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Dates
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Enumeration Date | 05/16/2008
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Last Update Date | 01/27/2009
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Provider Practice Location Address
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Address Line | 1515 E NATIONAL AVE
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City | BRAZIL
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State | IN
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Zip | 47834-2723
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Country | US
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Telephone | 812-448-1898
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Fax | 812-448-3838
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Provider Business Mailing Address
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Address Line | 1515 E NATIONAL AVE
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City | BRAZIL
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State | IN
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Zip | 47834-2723
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Country | US
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Telephone | 812-448-1898
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Fax | 812-448-3838
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Authorized Official
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Title or Position | OWNER
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Name | GARY NESTY
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Credential | DO
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Telephone | 812-448-1898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18001621
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License Number State | IN
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