Provider Demographics
NPI:1932496361
Name:ATTERHOLT, NATHAN LEO (OD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:LEO
Last Name:ATTERHOLT
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 1:1275 GLEN DR
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44654-8958
Mailing Address - Country:US
Mailing Address - Phone:419-685-3310
Mailing Address - Fax:
Practice Address - Street 1:1275 GLEN DR
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654-8958
Practice Address - Country:US
Practice Address - Phone:330-674-6121
Practice Address - Fax:330-674-7409
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6010T2925152WC0802X, 152WL0500X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics