Individual
NICHOLAS SHASHATI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
104 KASSON RD, CAMILLUS, NY 13031-2248
(315) 487-0327
Mailing address
12228 BRANICOLE LN, SAN DIEGO, CA 92129-5003
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1728
OR
152W00000X
Optometrist
Primary
4469
NY
152W00000X
Optometrist
660
AZ
152W00000X
Optometrist
8124
CA
Other
Enumeration date
07/09/2007
Last updated
06/03/2022
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