Provider Demographics
NPI:1376830463
Name:BRESLOW, NADINE MIRANDA (OD)
Entity Type:Individual
Prefix:DR
First Name:NADINE
Middle Name:MIRANDA
Last Name:BRESLOW
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 1:6500 SAWMILL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4942
Mailing Address - Country:US
Mailing Address - Phone:614-734-2685
Mailing Address - Fax:
Practice Address - Street 1:6500 SAWMILL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4942
Practice Address - Country:US
Practice Address - Phone:614-734-2685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6019152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist