Provider Demographics
NPI:1093827461
Name:NEVINS, FREDERIC K (OD)
Entity Type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:K
Last Name:NEVINS
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 1:22 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7902
Mailing Address - Country:US
Mailing Address - Phone:212-807-0019
Mailing Address - Fax:212-727-2395
Practice Address - Street 1:22 W 13TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7902
Practice Address - Country:US
Practice Address - Phone:212-807-0019
Practice Address - Fax:212-727-2395
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003280152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY201720POtherHIP
NY00330025Medicaid
NY110684OtherEYEMED
NY56329OtherAETNA
NYP673941OtherOXFORD
NY1C7757OtherHEALTHNET
NY0035445OtherGHI
NY56329OtherAETNA
NYT49156Medicare UPIN
NY00330025Medicaid
NYP673941OtherOXFORD