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General NPI Number Information
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NPI Number | 1578651618
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Entity Type | Organization
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Legal Business Name | NIETLING OPTICAL, P.A.
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 08/30/2021
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Provider Practice Location Address
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Address Line | 417 W MAIN ST
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City | DENISON
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State | TX
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Zip | 75020-3126
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Country | US
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Telephone | 903-465-3815
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Fax |
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Provider Business Mailing Address
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Address Line | 417 W MAIN ST
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City | DENISON
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State | TX
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Zip | 75020-3126
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Country | US
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Telephone | 903-465-3815
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/PRESIDENT
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Name | DENNIS M. NIETLING
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Credential | O.D.
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Telephone | 903-465-3815
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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 | 2861TG
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License Number State | TX
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