Provider Demographics
NPI:1538320288
Name:NELSON, RYAN W (OD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:W
Last Name:NELSON
Suffix:
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 1:915 ROBINS SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:ROBINS
Mailing Address - State:IA
Mailing Address - Zip Code:52328-9649
Mailing Address - Country:US
Mailing Address - Phone:319-294-8888
Mailing Address - Fax:319-294-4299
Practice Address - Street 1:915 ROBINS SQUARE DR
Practice Address - Street 2:
Practice Address - City:ROBINS
Practice Address - State:IA
Practice Address - Zip Code:52328-9649
Practice Address - Country:US
Practice Address - Phone:319-294-8888
Practice Address - Fax:319-294-4299
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002436152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0461921Medicaid
IA0260340001Medicare NSC
IA0260340003Medicare NSC
IA0260340002Medicare NSC