Provider Demographics
NPI:1760045231
Name:NAISER, NANCY M (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:NAISER
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 W PIKE ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2310
Mailing Address - Country:US
Mailing Address - Phone:859-431-2266
Mailing Address - Fax:859-431-6868
Practice Address - Street 1:140 W PIKE ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-2310
Practice Address - Country:US
Practice Address - Phone:859-431-2266
Practice Address - Fax:859-431-6868
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101312237700000X
KY111631156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty