Provider Demographics
NPI:1346305869
Name:GETZ, NINA COLEEN (OD)
Entity Type:Individual
Prefix:MRS
First Name:NINA
Middle Name:COLEEN
Last Name:GETZ
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 1:1834 W MOSSBERG AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2611
Mailing Address - Country:US
Mailing Address - Phone:626-688-5947
Mailing Address - Fax:
Practice Address - Street 1:301 W HUNTINGTON DR STE 605
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-1514
Practice Address - Country:US
Practice Address - Phone:626-446-1600
Practice Address - Fax:626-446-9986
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT9455152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT9455OtherLICENSE #
CAW18397Medicare ID - Type UnspecifiedGROUP MEDICARE ID #
CAOPT9455OtherLICENSE #