MEDICARE: PAIGE NITZ 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	3236	OK

General Provider Information

NPI Number	:	1831084896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAIGE NITZ OD

Provider Business Mailing Address
First Line	:	107 E GARLAND ST
Second Line	:
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761-2558
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1013 S MAIN ST
Second Line	:
City	:	GROVE
State	:	OK
Zip	:	74344-2847
Country	:	US
Telephone Number	:	918-786-9777
Fax Number	:

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

Provider Enumeration Date	:	06/10/2025
Last Update Date	:	06/10/2025

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Directions to “ PAIGE NITZ OD” Practice Location

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