Basic Information
| Provider Information | |||||||||
| NPI: | 1982619607 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NESTOR | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | OPTOMETRIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2817 REILLY ROAD | ||||||||
| Address2: | WOMACK ARMY MEDICAL CENTER MCXC-COD CREDENTIALS | ||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109078922 | ||||||||
| FaxNumber: | 9109076069 | ||||||||
| Practice Location | |||||||||
| Address1: | 2817 REILLY ROAD | ||||||||
| Address2: | WOMACK ARMY MEDICAL CENTER MCXC-COD CREDENTIALS | ||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109078922 | ||||||||
| FaxNumber: | 9109076069 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 02/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1688 | NC | N | Eye and Vision Services Providers | Optometrist | 152WC0802X | 1638 | NC | Y | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management |
No ID Information.