Physician Compare National (NPI:1376647396)

HEALTHCARE PROVIDER: NICKOLAS ANDREW VASTIS O.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1376647396
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9234208307
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080514000915
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	VASTIS
	Individual professional last name
Provider First Name	NICKOLAS
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	ILLINOIS COLLEGE OF OPTOMETRY AT CHICAGO
	Individual professional's medical school
Graduation Year	2006
	Individual professional's medical school graduation year
Primary Specialty	OPTOMETRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1510 ONYX RDG
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 101
	Group Practice or individual's line 2 address
City	FORT MILL
	Group Practice or individual's city
State	SC
	Group Practice or individual's state
Zip Code	297088970
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y