Provider Demographics
NPI:1063662625
Name:DAVID L NELSON, DOCTOR OF OPTOMETRY, PA
Entity Type:Organization
Organization Name:DAVID L NELSON, DOCTOR OF OPTOMETRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-938-2555
Mailing Address - Street 1:2306 E END BLVD S
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75672-7469
Mailing Address - Country:US
Mailing Address - Phone:903-938-2555
Mailing Address - Fax:903-938-1011
Practice Address - Street 1:2306 E END BLVD S
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75672-7469
Practice Address - Country:US
Practice Address - Phone:903-938-2555
Practice Address - Fax:903-938-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1923TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0891290001Medicare NSC
TX00E74AMedicare PIN
TX410012562Medicare PIN
TXP00638269Medicare PIN