Provider Demographics
NPI:1720064579
Name:NITARDY, JON JOEL (OD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:JOEL
Last Name:NITARDY
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 1:1000 FM 300
Mailing Address - Street 2:
Mailing Address - City:LEVELLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79336-6235
Mailing Address - Country:US
Mailing Address - Phone:806-894-7842
Mailing Address - Fax:806-894-3378
Practice Address - Street 1:750 SUNLAND PARK DRIVE
Practice Address - Street 2:STE G1
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912
Practice Address - Country:US
Practice Address - Phone:915-585-1928
Practice Address - Fax:915-833-9626
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6556T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist