Provider Demographics
NPI:1619395894
Name:NIELSEN VISION DEVELOPMENT CENTER, LLC
Entity Type:Organization
Organization Name:NIELSEN VISION DEVELOPMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEIGHA
Authorized Official - Middle Name:MISHELLE
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-590-2485
Mailing Address - Street 1:17460 INTERSTATE 35 N
Mailing Address - Street 2:STE. 412
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1243
Mailing Address - Country:US
Mailing Address - Phone:210-590-2485
Mailing Address - Fax:210-579-9490
Practice Address - Street 1:17460 INTERSTATE 35 N
Practice Address - Street 2:STE. 412
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1243
Practice Address - Country:US
Practice Address - Phone:210-590-2485
Practice Address - Fax:210-579-9490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7776152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty