Provider Demographics
NPI:1891834776
Name:WEBER, NICHOLAS BRIAN (OD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:BRIAN
Last Name:WEBER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2119 CARTER AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7733
Mailing Address - Country:US
Mailing Address - Phone:606-329-2243
Mailing Address - Fax:606-324-2395
Practice Address - Street 1:432 PRIVATE DRIVE 288
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680-7900
Practice Address - Country:US
Practice Address - Phone:740-894-4749
Practice Address - Fax:740-894-4827
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5251T2155152W00000X
KY2020DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2270742Medicaid
OH$$$$$$$$$OtherSSN
OHU86147Medicare UPIN