Provider Demographics
NPI:1720397805
Name:NISBET, CHRISTOPHER ALLEN (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ALLEN
Last Name:NISBET
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:69 ALLEN ST
Mailing Address - Street 2:SUITE 15
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4564
Mailing Address - Country:US
Mailing Address - Phone:802-775-0038
Mailing Address - Fax:802-747-0602
Practice Address - Street 1:69 ALLEN ST
Practice Address - Street 2:SUITE 15
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4564
Practice Address - Country:US
Practice Address - Phone:802-775-0038
Practice Address - Fax:802-747-0602
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-06
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT030.0097095152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist