Basic Information
Provider Information
NPI: 1003004870
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GIRGIS
FirstName: NADINE
MiddleName: M
NamePrefix: DR.
NameSuffix:  
Credential: O.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3200 S UNIVERSITY DR
Address2:  
City: DAVIE
State: FL
PostalCode: 333282018
CountryCode: US
TelephoneNumber: 9542621728
FaxNumber: 9542621818
Practice Location
Address1: 3200 S UNIVERSITY DR
Address2:  
City: DAVIE
State: FL
PostalCode: 333282018
CountryCode: US
TelephoneNumber: 9542621728
FaxNumber: 9542621818
Other Information
ProviderEnumerationDate: 10/05/2007
LastUpdateDate: 10/05/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
152W00000XOPC4221FLY Eye and Vision Services ProvidersOptometrist 

No ID Information.


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