Provider Demographics
NPI:1639788961
Name:NELSON, BRANDEE (OD)
Entity Type:Individual
Prefix:
First Name:BRANDEE
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 ROGERS RD STE 110
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4196
Mailing Address - Country:US
Mailing Address - Phone:586-719-0306
Mailing Address - Fax:
Practice Address - Street 1:3150 ROGERS RD STE 110
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4196
Practice Address - Country:US
Practice Address - Phone:586-719-0306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2668152W00000X
TN3639152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist