Provider Demographics
NPI:1518925890
Name:NOTHNAGEL, VICTOR T (OD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:T
Last Name:NOTHNAGEL
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 1:2332 HIGHWAY 44 W
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34453-3856
Mailing Address - Country:US
Mailing Address - Phone:352-726-2085
Mailing Address - Fax:352-726-2738
Practice Address - Street 1:2332 HIGHWAY 44 W
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453-3856
Practice Address - Country:US
Practice Address - Phone:352-726-2085
Practice Address - Fax:352-726-2738
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1363152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0000181OtherPRESCRIPTION NUMBER
FL0000181OtherPRESCRIPTION NUMBER
FLT94135Medicare UPIN