Provider Demographics
NPI:1558561183
Name:ORR, NATHAN (OD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:ORR
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 1:3581 MT DIABLO BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3891
Mailing Address - Country:US
Mailing Address - Phone:925-283-8502
Mailing Address - Fax:925-283-6736
Practice Address - Street 1:3581 MT DIABLO BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3891
Practice Address - Country:US
Practice Address - Phone:925-283-8502
Practice Address - Fax:925-283-6736
Is Sole Proprietor?:No
Enumeration Date:2007-07-22
Last Update Date:2007-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13334T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist