Provider Demographics
NPI:1639302821
Name:NELSON EYECARE GROUP, LLC
Entity Type:Organization
Organization Name:NELSON EYECARE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:903-487-0550
Mailing Address - Street 1:8401 MEMORIAL LN
Mailing Address - Street 2:APT. 4307
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2285
Mailing Address - Country:US
Mailing Address - Phone:501-779-5728
Mailing Address - Fax:
Practice Address - Street 1:3333 N US HIGHWAY 75
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2525
Practice Address - Country:US
Practice Address - Phone:903-487-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-03
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7389T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty