Provider Demographics
NPI:1831233279
Name:GRESHAM, NANCY ELIZABETH (OD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ELIZABETH
Last Name:GRESHAM
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 1:19 LANDON LN
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-3831
Mailing Address - Country:US
Mailing Address - Phone:912-898-8250
Mailing Address - Fax:
Practice Address - Street 1:7810 ABERCORN ST
Practice Address - Street 2:SEARS OPTICAL
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2440
Practice Address - Country:US
Practice Address - Phone:912-354-0773
Practice Address - Fax:912-351-0668
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001049152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00661614AMedicaid
GAU35674Medicare UPIN
GA41ZCCCHMedicare ID - Type Unspecified