Provider Demographics
NPI:1871597864
Name:FORCHE, NADINE G (OD)
Entity type:Individual
Prefix:DR
First Name:NADINE
Middle Name:G
Last Name:FORCHE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:NADINE
Other - Middle Name:
Other - Last Name:HUMEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:698 S MILLEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-1251
Mailing Address - Country:US
Mailing Address - Phone:706-543-2020
Mailing Address - Fax:706-549-6618
Practice Address - Street 1:698 S MILLEDGE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-1251
Practice Address - Country:US
Practice Address - Phone:706-543-2020
Practice Address - Fax:706-549-6618
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA1739152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000831388AMedicaid
GA667221OtherBCBS-GA
GA582102247OtherCOMMERCIAL
GA41ZCDMGMedicare ID - Type Unspecified
GA000831388AMedicaid