MEDICARE: NICOLAS GILBERG 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	0618001984	VA
2	152W00000X	Optometrist	OPC4531	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700191244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLAS GILBERG OD

Provider Business Mailing Address
First Line	:	13100 CORONADO DR
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2154
Country	:	US
Telephone Number	:	786-500-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	14711 BISCAYNE BLVD STE 308
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-1213
Country	:	US
Telephone Number	:	786-500-2020
Fax Number	:

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

Provider Enumeration Date	:	08/09/2010
Last Update Date	:	12/09/2018

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