Provider Demographics
NPI:1083092126
Name:ZAGORIANOS, NIKOLAOS CHRISTOS (OD)
Entity Type:Individual
Prefix:DR
First Name:NIKOLAOS
Middle Name:CHRISTOS
Last Name:ZAGORIANOS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 BLUEGRASS AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1179
Mailing Address - Country:US
Mailing Address - Phone:502-364-0033
Mailing Address - Fax:502-361-4488
Practice Address - Street 1:1935 BLUEGRASS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1179
Practice Address - Country:US
Practice Address - Phone:502-364-0033
Practice Address - Fax:502-361-4488
Is Sole Proprietor?:No
Enumeration Date:2015-05-08
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8434T152W00000X
IN18003891A152W00000X
KY1975DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100359770Medicaid
IN201308240Medicaid
KY7100359770Medicaid
IN331420005Medicare PIN