Provider Demographics
NPI:1235442302
Name:NELMS, BRANDON VAN (OD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:VAN
Last Name:NELMS
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1011 STONEBRIDGE PKWY
Mailing Address - Street 2:STE 106
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-6011
Mailing Address - Country:US
Mailing Address - Phone:706-310-5050
Mailing Address - Fax:706-310-5053
Practice Address - Street 1:1011 STONEBRIDGE PKWY
Practice Address - Street 2:STE 106
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-6011
Practice Address - Country:US
Practice Address - Phone:706-310-5050
Practice Address - Fax:706-310-5053
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN2933152W00000X
GA2905152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist