Individual
NICHOLAS TYLER PERICHAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D, M.S.
Contact information
Practice address
1010 N 21ST ST, NEWARK, OH 43055-2984
(740) 366-5050
Mailing address
1010 N 21ST ST, NEWARK, OH 43055-2984
(740) 366-5050
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
6400
OH
Other
Enumeration date
06/11/2015
Last updated
06/11/2015
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