Provider Demographics
NPI:1609036292
Name:RIVERA, NELSON (OD)
Entity Type:Individual
Prefix:MR
First Name:NELSON
Middle Name:
Last Name:RIVERA
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:PO BOX 117025
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75011-7025
Mailing Address - Country:US
Mailing Address - Phone:214-783-5965
Mailing Address - Fax:
Practice Address - Street 1:2110 LARKSPUR DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4134
Practice Address - Country:US
Practice Address - Phone:469-892-6629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6002T152W00000X
PR446152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist