MEDICARE: NANDINI LOHITHASWA O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4901004727	MI

General Provider Information

NPI Number	:	1194150243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANDINI LOHITHASWA O.D.

Provider Business Mailing Address
First Line	:	2623 PLYMOUTH RD
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48105-2468
Country	:	US
Telephone Number	:	734-930-2373
Fax Number	:

Provider Business Practice Location Address
First Line	:	3271 UNION LAKE RD
Second Line	:
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48382-4550
Country	:	US
Telephone Number	:	248-387-9595
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2013
Last Update Date	:	04/26/2018

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