Provider Demographics
NPI:1528139284
Name:VROUVAS, NICHOLAS P (OD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:P
Last Name:VROUVAS
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 1:450 SUTTER ST
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4011
Mailing Address - Country:US
Mailing Address - Phone:415-362-2030
Mailing Address - Fax:415-362-2327
Practice Address - Street 1:450 SUTTER ST
Practice Address - Street 2:SUITE 1500
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4011
Practice Address - Country:US
Practice Address - Phone:415-362-2030
Practice Address - Fax:415-362-2327
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5476152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12937Medicare ID - Type Unspecified
T10004Medicare UPIN