Provider Demographics
NPI:1770562340
Name:NASH, GARY C (OD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:C
Last Name:NASH
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 1:316 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-4402
Mailing Address - Country:US
Mailing Address - Phone:336-838-4801
Mailing Address - Fax:336-838-0938
Practice Address - Street 1:316 MAIN ST
Practice Address - Street 2:
Practice Address - City:N WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-4402
Practice Address - Country:US
Practice Address - Phone:336-838-4801
Practice Address - Fax:336-838-0938
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC 1123152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09648OtherBCBS
NC8909648Medicaid
NC804503OtherPARTNERS
NC0448900001OtherMEDICARE DME
NC0448900001OtherMEDICARE DME
NCT64960Medicare UPIN