Provider Demographics
NPI:1205936838
Name:NIXON, CHAD ROBERT (OD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:ROBERT
Last Name:NIXON
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 1:2674 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-8544
Mailing Address - Country:US
Mailing Address - Phone:517-546-9242
Mailing Address - Fax:
Practice Address - Street 1:2674 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-8544
Practice Address - Country:US
Practice Address - Phone:517-546-9242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4901004200OtherSTATE LICENSE NUMBER
MI4787760Medicaid
MI900D710780OtherBLUE CROSS BLUE SHIELD
MI4787760Medicaid
MI4901004200OtherSTATE LICENSE NUMBER
MI900D710780OtherBLUE CROSS BLUE SHIELD