Provider Demographics
NPI:1821578170
Name:NUSGART, ADAM (OD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:NUSGART
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 1:855 W MARKET ST
Mailing Address - Street 2:STE A
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2764
Mailing Address - Country:US
Mailing Address - Phone:419-228-7432
Mailing Address - Fax:
Practice Address - Street 1:PERRY POINT VA MEDICAL CENTER
Practice Address - Street 2:OPTOMETRY CLINIC (11CI)
Practice Address - City:PERRY POINT
Practice Address - State:MD
Practice Address - Zip Code:21902
Practice Address - Country:US
Practice Address - Phone:410-642-2411
Practice Address - Fax:410-642-1048
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.006677152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist