Provider Demographics
NPI:1619154549
Name:PHILIP G NIX OD
Entity Type:Organization
Organization Name:PHILIP G NIX OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:G
Authorized Official - Last Name:NIX
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:765-284-8460
Mailing Address - Street 1:4801 W CLARA LN
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-5548
Mailing Address - Country:US
Mailing Address - Phone:765-284-8460
Mailing Address - Fax:765-284-0943
Practice Address - Street 1:4801 W CLARA LN
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5548
Practice Address - Country:US
Practice Address - Phone:765-284-8460
Practice Address - Fax:765-284-0943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001928A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty