Provider Demographics
NPI:1710212022
Name:NELSON, MARK E (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:NELSON
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 1:8401 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 S HIGHWAY 75
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-9377
Practice Address - Country:US
Practice Address - Phone:903-487-0550
Practice Address - Fax:903-813-0375
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7389T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist