Provider Demographics
NPI:1992197610
Name:NASSER, WALID
Entity Type:Individual
Prefix:
First Name:WALID
Middle Name:
Last Name:NASSER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25102 BROOKPARK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-6414
Mailing Address - Country:US
Mailing Address - Phone:440-734-1030
Mailing Address - Fax:440-734-0564
Practice Address - Street 1:25102 BROOKPARK RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-6414
Practice Address - Country:US
Practice Address - Phone:440-734-1030
Practice Address - Fax:440-734-0564
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS 5864156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician