Provider Demographics
NPI:1477953172
Name:DIRKS, NATHAN (OD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:DIRKS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 MCGARITY LN STE 300
Mailing Address - Street 2:
Mailing Address - City:LUCAS
Mailing Address - State:TX
Mailing Address - Zip Code:75002-7526
Mailing Address - Country:US
Mailing Address - Phone:469-949-2020
Mailing Address - Fax:469-444-0002
Practice Address - Street 1:2695 MCGARITY LN STE 300
Practice Address - Street 2:
Practice Address - City:LUCAS
Practice Address - State:TX
Practice Address - Zip Code:75002-7526
Practice Address - Country:US
Practice Address - Phone:469-949-2020
Practice Address - Fax:469-444-0002
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8547TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist