Provider Demographics
NPI:1346689080
Name:SHISSIAS, NICKOLAS J (OD)
Entity Type:Individual
Prefix:DR
First Name:NICKOLAS
Middle Name:J
Last Name:SHISSIAS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 HADDON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08091-1607
Mailing Address - Country:US
Mailing Address - Phone:856-768-2515
Mailing Address - Fax:856-768-7451
Practice Address - Street 1:204 HADDON AVE
Practice Address - Street 2:
Practice Address - City:WEST BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08091-1607
Practice Address - Country:US
Practice Address - Phone:856-768-2515
Practice Address - Fax:856-768-7451
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-16
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE14-0000066152W00000X
NJ27OA00657600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist