Provider Demographics
NPI:1164519690
Name:STEINER, NIDA (OD)
Entity Type:Individual
Prefix:DR
First Name:NIDA
Middle Name:
Last Name:STEINER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:NIDA
Other - Middle Name:
Other - Last Name:PETIKUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:6553 ROLLING FORK DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-3954
Mailing Address - Country:US
Mailing Address - Phone:615-942-8052
Mailing Address - Fax:
Practice Address - Street 1:6553 ROLLING FORK DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-3954
Practice Address - Country:US
Practice Address - Phone:615-942-8052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4532T152W00000X
TNOD2788152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80833QOtherBLUE CROSS BLUE SHIELD
TX142002802Medicaid
TX142002802Medicaid
TX8A7650Medicare ID - Type Unspecified