MEDICARE: DR. NATHAN LEO ATTERHOLT 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	152WC0802X	Corneal and Contact Management Optometrist	6010T2925	OH
2	152WL0500X	Low Vision Rehabilitation Optometrist	6010T2925	OH
3	152WP0200X	Pediatric Optometrist	6010T2925	OH
4	152W00000X	Optometrist	6010T2925	OH

General Provider Information

NPI Number	:	1932496361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN LEO ATTERHOLT O.D.

Provider Business Mailing Address
First Line	:	1275 GLEN DR
Second Line	:
City	:	MILLERSBURG
State	:	OH
Zip	:	44654-8958
Country	:	US
Telephone Number	:	419-685-3310
Fax Number	:

Provider Business Practice Location Address
First Line	:	1275 GLEN DR
Second Line	:
City	:	MILLERSBURG
State	:	OH
Zip	:	44654-8958
Country	:	US
Telephone Number	:	330-674-6121
Fax Number	:	330-674-7409

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

Provider Enumeration Date	:	07/06/2011
Last Update Date	:	10/10/2017

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