Provider Demographics
NPI:1437338662
Name:DR. STANLEY J. NELSON
Entity Type:Organization
Organization Name:DR. STANLEY J. NELSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-562-2631
Mailing Address - Street 1:715 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66508-1841
Mailing Address - Country:US
Mailing Address - Phone:785-562-2631
Mailing Address - Fax:785-562-4006
Practice Address - Street 1:715 BROADWAY
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66508-1841
Practice Address - Country:US
Practice Address - Phone:785-562-2631
Practice Address - Fax:785-562-4006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1124-3332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100250616-00Medicaid
KS0000005204OtherBLUE CROSS/BLUE SHIELD
KS005204OtherMEDICARE
KST43697Medicare UPIN
NE100250616-00Medicaid