Provider Demographics
NPI:1699347013
Name:NIVAR, GABRIELLE CESARINA (OD)
Entity type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:CESARINA
Last Name:NIVAR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 PINERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6789
Mailing Address - Country:US
Mailing Address - Phone:740-361-9532
Mailing Address - Fax:
Practice Address - Street 1:83 CAMBRIDGE ST STE 1D
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4181
Practice Address - Country:US
Practice Address - Phone:740-361-9532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2736152W00000X
MA5495152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist