Provider Demographics
NPI:1902958788
Name:NASH, BRIAN SCOTT I (LDO)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:SCOTT
Last Name:NASH
Suffix:I
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-1749
Mailing Address - Country:US
Mailing Address - Phone:330-725-3937
Mailing Address - Fax:330-725-5434
Practice Address - Street 1:707 N COURT ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1749
Practice Address - Country:US
Practice Address - Phone:330-725-3937
Practice Address - Fax:330-725-5434
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2010-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3483-S156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0682440001Medicare UPIN