MEDICARE: WALID NASSER

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	156FX1800X	Optician	S 5864	OH

General Provider Information

NPI Number	:	1992197610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALID NASSER

Provider Business Mailing Address
First Line	:	25102 BROOKPARK RD
Second Line	:
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070-6414
Country	:	US
Telephone Number	:	440-734-1030
Fax Number	:	440-734-0564

Provider Business Practice Location Address
First Line	:	25102 BROOKPARK RD
Second Line	:
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070-6414
Country	:	US
Telephone Number	:	440-734-1030
Fax Number	:	440-734-0564

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

Provider Enumeration Date	:	03/04/2015
Last Update Date	:	03/04/2015

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