Provider Demographics
NPI:1659926160
Name:NEBELSICK, JONATHAN PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:PAUL
Last Name:NEBELSICK
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 1:200 S CHICAGO ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57747-2322
Mailing Address - Country:US
Mailing Address - Phone:605-999-0152
Mailing Address - Fax:
Practice Address - Street 1:200 S CHICAGO ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747-2322
Practice Address - Country:US
Practice Address - Phone:605-745-3175
Practice Address - Fax:605-745-4006
Is Sole Proprietor?:No
Enumeration Date:2019-08-02
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD759152W00000X
HIOD-980152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist