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General NPI Number Information
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NPI Number | 1477534253
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Entity Type | Individual
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Provider Name | BRIAN SCOTT NISHEK OD
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Gender | Male
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Dates
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Enumeration Date | 11/09/2005
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Last Update Date | 12/04/2012
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Provider Practice Location Address
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Address Line | 324 N HIGHWAY 16
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City | DENVER
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State | NC
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Zip | 28037-8012
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Country | US
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Telephone | 704-483-2263
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Fax | 704-483-6136
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Provider Business Mailing Address
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Address Line | 324 N HIGHWAY 16
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City | DENVER
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State | NC
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Zip | 28037-8012
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Country | US
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Telephone | 704-483-2263
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Fax | 704-483-6136
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1819
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License Number State | NC
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