Provider Demographics
NPI:1760680508
Name:NELSON-HARTMAN, MEGAN BETH (OD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:BETH
Last Name:NELSON-HARTMAN
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 1:1288 DAKOTA AVE S STE 3
Mailing Address - Street 2:PO BOX 948
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-3103
Mailing Address - Country:US
Mailing Address - Phone:605-352-4181
Mailing Address - Fax:
Practice Address - Street 1:1288 DAKOTA AVE S STE 3
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-3675
Practice Address - Country:US
Practice Address - Phone:605-352-4181
Practice Address - Fax:605-352-4189
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD639152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist