Provider Demographics
NPI:1235260340
Name:RICHARD L. NELSON, O.D. P.L.C.
Entity Type:Organization
Organization Name:RICHARD L. NELSON, O.D. P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:515-961-7573
Mailing Address - Street 1:12817 FORD TRL S
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50125-8930
Mailing Address - Country:US
Mailing Address - Phone:515-961-7573
Mailing Address - Fax:515-961-7586
Practice Address - Street 1:1500 N JEFFERSON WAY
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-1465
Practice Address - Country:US
Practice Address - Phone:515-961-7573
Practice Address - Fax:515-961-7586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01595152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI10145Medicare ID - Type Unspecified