Provider Demographics
NPI:1992790166
Name:XANTHOS, NICHOLAS (OD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:XANTHOS
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 1:46 EAGLE ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-3104
Mailing Address - Country:US
Mailing Address - Phone:973-560-1500
Mailing Address - Fax:973-560-0419
Practice Address - Street 1:46 EAGLE ROCK AVE
Practice Address - Street 2:
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936-3104
Practice Address - Country:US
Practice Address - Phone:973-560-1500
Practice Address - Fax:973-560-0419
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27T000109900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU87549Medicare UPIN