Provider Demographics
NPI:1518324169
Name:NELSON VISION PA
Entity Type:Organization
Organization Name:NELSON VISION PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:361-549-9495
Mailing Address - Street 1:PO BOX 1593
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-1904
Mailing Address - Country:US
Mailing Address - Phone:361-549-9495
Mailing Address - Fax:281-966-6960
Practice Address - Street 1:20 SUNILAND DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-6341
Practice Address - Country:US
Practice Address - Phone:361-549-9495
Practice Address - Fax:281-966-6960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5992TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty