Provider Demographics
NPI:1184146771
Name:MORROW, NATHAN MOORE (OD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:MOORE
Last Name:MORROW
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9202 N MERIDIAN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1810
Mailing Address - Country:US
Mailing Address - Phone:317-841-2020
Mailing Address - Fax:317-570-7433
Practice Address - Street 1:9202 N MERIDIAN ST STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1810
Practice Address - Country:US
Practice Address - Phone:317-841-2020
Practice Address - Fax:317-570-7433
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004104A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300018335Medicaid
GAOPT003014OtherGEORGIA BOARD OF OPTOMETRY