Provider Demographics
NPI:1780643866
Name:HERLEVICH, NANCY E (OD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:E
Last Name:HERLEVICH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4650 NW 39TH PLACE
Mailing Address - Street 2:SUITE D
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-8157
Mailing Address - Country:US
Mailing Address - Phone:352-373-0000
Mailing Address - Fax:352-376-8908
Practice Address - Street 1:4650 NW 39TH PLACE
Practice Address - Street 2:SUITE D
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606
Practice Address - Country:US
Practice Address - Phone:352-373-0000
Practice Address - Fax:352-373-0595
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3009152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
259466OtherAVMED
068805OtherVISTA
U63867Medicare UPIN
259466OtherAVMED