Provider Demographics
NPI:1043521941
Name:LIVINGSTON, NESSA (OD)
Entity Type:Individual
Prefix:DR
First Name:NESSA
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 SW 5TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8601
Mailing Address - Country:US
Mailing Address - Phone:208-370-2020
Mailing Address - Fax:
Practice Address - Street 1:413 SW 5TH AVE
Practice Address - Street 2:STE 100
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8364
Practice Address - Country:US
Practice Address - Phone:208-370-2020
Practice Address - Fax:208-600-6899
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP100470152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist