Provider Demographics
NPI:1710984067
Name:NEVELOW, JOHN M (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:NEVELOW
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19190 STONE OAK PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3237
Mailing Address - Country:US
Mailing Address - Phone:210-349-2437
Mailing Address - Fax:210-494-1633
Practice Address - Street 1:19190 STONE OAK PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3237
Practice Address - Country:US
Practice Address - Phone:210-349-2437
Practice Address - Fax:210-494-1633
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2061TG152W00000X
TXMN0265923152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX741764072OtherPROVIDER NUMBER
TX00E11HOtherBLUECROSSBLUESHIELD
TX2326241OtherAETNA
TX741764072OtherPROVIDER NUMBER
TX2326241OtherAETNA
TXT15023Medicare UPIN