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NPI Code Detail

MEDICARE: GREGORY NIXON O.D.

MEDICARE: GREGORY NIXON 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
1152W00000XOptometrist4773-T1577OH

Other Identifiers

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

General Provider Information

NPI Number : 1972629467
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY NIXON O.D.
Provider Business Mailing Address
First Line : 1664 NEIL AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43201-2333
Country : US
Telephone Number : 614-292-2020
Fax Number : 614-247-4543
Provider Business Practice Location Address
First Line : 1664 NEIL AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43201-2333
Country : US
Telephone Number : 614-292-2020
Fax Number : 614-247-4543
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2007
Last Update Date : 12/10/2020

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