Individual
DR. FREDERICK MATTHEW NISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1310 CRAMER CIRCLE, PENNOCK 506, BIG RAPIDS, MI 49307-2738
(231) 591-2222
(231) 591-3991
Mailing address
1310 CRAMER CIRCLE, PENNOCK 506, BIG RAPIDS, MI 49307-2738
(231) 591-2222
(231) 591-3991
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901002465
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
078466001020
ADMINISTAR
MI
05
—
4401859
—
MI
01
—
FN002465
BLUE CROSS
MI
Enumeration date
07/21/2006
Last updated
07/08/2007
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