Provider Demographics
NPI:1558307710
Name:NILSEN, ERIC PATRICK (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:PATRICK
Last Name:NILSEN
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 1:601 N COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-4062
Mailing Address - Country:US
Mailing Address - Phone:804-858-2020
Mailing Address - Fax:804-423-9090
Practice Address - Street 1:601 N COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23236-4062
Practice Address - Country:US
Practice Address - Phone:804-858-2022
Practice Address - Fax:804-423-9090
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000736152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00X487D01Medicare PIN