Provider Demographics
NPI:1760461727
Name:NIBERT, BYRON J (OD)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:J
Last Name:NIBERT
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 1:140 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901
Mailing Address - Country:US
Mailing Address - Phone:304-469-6711
Mailing Address - Fax:304-465-8332
Practice Address - Street 1:140 MAIN ST
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901
Practice Address - Country:US
Practice Address - Phone:304-469-6711
Practice Address - Fax:304-465-8332
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV737OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1450173OtherUMWA FUNDS
WV0012610000Medicaid
550614245002OtherBCBS
WV9254871Medicare ID - Type Unspecified
WV0012610000Medicaid