Provider Demographics
NPI:1114202223
Name:POLLIC, NINA J (OPTICIAN)
Entity Type:Individual
Prefix:MS
First Name:NINA
Middle Name:J
Last Name:POLLIC
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 STATE ROUTE 29
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:NY
Mailing Address - Zip Code:12834-6109
Mailing Address - Country:US
Mailing Address - Phone:518-692-2960
Mailing Address - Fax:518-692-8826
Practice Address - Street 1:1153 STATE ROUTE 29
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:NY
Practice Address - Zip Code:12834-6109
Practice Address - Country:US
Practice Address - Phone:518-692-2960
Practice Address - Fax:518-692-8826
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008622-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician