Provider Demographics
NPI:1700191244
Name:GILBERG, NICOLAS (OD)
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:
Last Name:GILBERG
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 1:13100 CORONADO DR
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2154
Mailing Address - Country:US
Mailing Address - Phone:786-500-2020
Mailing Address - Fax:
Practice Address - Street 1:14711 BISCAYNE BLVD STE 308
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-1213
Practice Address - Country:US
Practice Address - Phone:786-500-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2018-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001984152W00000X
FLOPC4531152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist