MEDICARE: EMILY NIXON OD

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	18004332A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18004332A	OTHER	IN	INDIANA BOARD OF OPTOMETEY

General Provider Information

NPI Number	:	1235862632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY NIXON OD

Provider Business Mailing Address
First Line	:	401 HENRY ST
Second Line	:
City	:	NORTH VERNON
State	:	IN
Zip	:	47265-1003
Country	:	US
Telephone Number	:	812-346-2020
Fax Number	:	812-346-4636

Provider Business Practice Location Address
First Line	:	401 HENRY ST
Second Line	:
City	:	NORTH VERNON
State	:	IN
Zip	:	47265-1003
Country	:	US
Telephone Number	:	812-346-2020
Fax Number	:

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

Provider Enumeration Date	:	07/05/2022
Last Update Date	:	03/20/2026

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