Provider Demographics
NPI:1609918390
Name:DAVID A NELSON OD PA LLC
Entity Type:Organization
Organization Name:DAVID A NELSON OD PA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-273-6717
Mailing Address - Street 1:4123 SW GAGE CENTER DR
Mailing Address - Street 2:SUITE 126
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1886
Mailing Address - Country:US
Mailing Address - Phone:785-273-6717
Mailing Address - Fax:785-228-2029
Practice Address - Street 1:4123 SW GAGE CENTER DR
Practice Address - Street 2:SUITE 126
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1886
Practice Address - Country:US
Practice Address - Phone:785-273-6717
Practice Address - Fax:785-228-2029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1357-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100219290BMedicaid
KS100219290BMedicaid
KS1278200001Medicare NSC
KSU35077Medicare UPIN