Provider Demographics
NPI:1881830537
Name:BUSCH, NANCY LORENE (OD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:LORENE
Last Name:BUSCH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19001 N 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-5036
Mailing Address - Country:US
Mailing Address - Phone:602-702-4394
Mailing Address - Fax:623-293-4436
Practice Address - Street 1:7750 W ARROWHEAD TOWNE CTR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8612
Practice Address - Country:US
Practice Address - Phone:623-412-8387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-31
Last Update Date:2019-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1360152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU52250Medicare UPIN