Provider Demographics
NPI:1700975778
Name:STYRON, NATHAN SHANE
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:SHANE
Last Name:STYRON
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 1:13244 US HWY 1
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-0000
Mailing Address - Country:US
Mailing Address - Phone:772-388-0308
Mailing Address - Fax:
Practice Address - Street 1:13244 US HWY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-0000
Practice Address - Country:US
Practice Address - Phone:772-388-0308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO4689156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1313220001Medicare NSC