Provider Demographics
NPI:1043262322
Name:FORST, NATHAN PAUL (OD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:PAUL
Last Name:FORST
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1212 S KOELLER ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-6170
Mailing Address - Country:US
Mailing Address - Phone:920-426-5730
Mailing Address - Fax:920-426-1708
Practice Address - Street 1:1300 S. KOELLER ROAD
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-6196
Practice Address - Country:US
Practice Address - Phone:920-426-5730
Practice Address - Fax:920-426-1708
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3029-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38626900Medicaid
WIV05841Medicare UPIN