Provider Demographics
NPI:1578707493
Name:NELSON, CRAIG L (OD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:L
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 1:9 N. BEECH ST.
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3205
Mailing Address - Country:US
Mailing Address - Phone:970-565-7200
Mailing Address - Fax:970-565-8203
Practice Address - Street 1:9 N. BEECH ST.
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3205
Practice Address - Country:US
Practice Address - Phone:970-565-7200
Practice Address - Fax:970-565-8203
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1409152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO43133Medicare PIN
COU36980Medicare UPIN