Provider Demographics
NPI:1285826545
Name:NELSON OPTICIANS, INC.
Entity Type:Organization
Organization Name:NELSON OPTICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:GALVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-232-4003
Mailing Address - Street 1:3324 ORION DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-4378
Mailing Address - Country:US
Mailing Address - Phone:515-232-4003
Mailing Address - Fax:515-232-4004
Practice Address - Street 1:3324 ORION DR
Practice Address - Street 2:SUITE 2
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-4378
Practice Address - Country:US
Practice Address - Phone:515-232-4003
Practice Address - Fax:515-232-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0190100001Medicare NSC