Provider Demographics
NPI:1588829121
Name:NELSON, KIERSTEN M (OD)
Entity Type:Individual
Prefix:DR
First Name:KIERSTEN
Middle Name:M
Last Name:NELSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:9795 CROSSPOINT BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3354
Mailing Address - Country:US
Mailing Address - Phone:317-254-6480
Mailing Address - Fax:317-259-8609
Practice Address - Street 1:1921 E 53RD ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-4029
Practice Address - Country:US
Practice Address - Phone:317-254-6480
Practice Address - Fax:317-259-8609
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN18003543A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200914970CMedicaid
IN000000665387OtherANTHEM BCBS
IN0873400012Medicare NSC
IN894060Medicare PIN