Provider Demographics
NPI:1477845469
Name:MINASSE, NARDOS (OD)
Entity type:Individual
Prefix:DR
First Name:NARDOS
Middle Name:
Last Name:MINASSE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17850 GARLAND GROH BLVD
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-1944
Mailing Address - Country:US
Mailing Address - Phone:301-714-1379
Mailing Address - Fax:301-714-0236
Practice Address - Street 1:17850 GARLAND GROH BLVD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-1944
Practice Address - Country:US
Practice Address - Phone:301-714-1379
Practice Address - Fax:301-714-0236
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET009112152W00000X
MDTA1261152W00000X
PAOEG002718152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist