Provider Demographics
NPI:1316945520
Name:OGLESBEE, NATHANAEL DAVID (OD)
Entity type:Individual
Prefix:DR
First Name:NATHANAEL
Middle Name:DAVID
Last Name:OGLESBEE
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 1:207 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:NAPPANEE
Mailing Address - State:IN
Mailing Address - Zip Code:46550-2119
Mailing Address - Country:US
Mailing Address - Phone:574-773-4732
Mailing Address - Fax:574-773-2164
Practice Address - Street 1:207 E MARKET ST
Practice Address - Street 2:
Practice Address - City:NAPPANEE
Practice Address - State:IN
Practice Address - Zip Code:46550-2119
Practice Address - Country:US
Practice Address - Phone:574-773-4732
Practice Address - Fax:574-773-2164
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001832B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN410004217OtherRAILROAD MEDICARE
IN0198900001OtherDMERC
IN100113090AMedicaid
IN100113090AMedicaid
IN0198900001OtherDMERC