Provider Demographics
NPI:1407803448
Name:KLAUS, NELSON C JR (OD)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:C
Last Name:KLAUS
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 SHIPYARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6151
Mailing Address - Country:US
Mailing Address - Phone:910-799-0220
Mailing Address - Fax:910-799-0478
Practice Address - Street 1:3910 SHIPYARD BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6151
Practice Address - Country:US
Practice Address - Phone:910-799-0220
Practice Address - Fax:910-799-0478
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC899152W00000X, 152WC0802X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09492OtherBLUE CROSS BLUE SHIELD
NC2220221OtherUNITED HEALTH CARE
NC8909492Medicaid
NC09492OtherBLUE CROSS BLUE SHIELD
NC8909492Medicaid