Provider Demographics
NPI:1518068287
Name:NIELSON OPTICAL PC
Entity Type:Organization
Organization Name:NIELSON OPTICAL PC
Other - Org Name:MELISSA NIELSEN OD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OD
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:NIELSON
Authorized Official - Last Name:ROST
Authorized Official - Suffix:
Authorized Official - Credentials:OD DOCTOR OF OPTOMET
Authorized Official - Phone:724-830-2452
Mailing Address - Street 1:482 AUSTRAW RD
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658
Mailing Address - Country:US
Mailing Address - Phone:724-238-0402
Mailing Address - Fax:
Practice Address - Street 1:2200 GREENGATE CENTER
Practice Address - Street 2:WAL MART VISION CENTER
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601
Practice Address - Country:US
Practice Address - Phone:724-830-2452
Practice Address - Fax:724-837-3361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET009008152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty