Provider Demographics
NPI:1851934699
Name:NELI, RESIOLA (OD)
Entity Type:Individual
Prefix:
First Name:RESIOLA
Middle Name:
Last Name:NELI
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 1:6115 TIDEWATER DR APT 453
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23509-0060
Mailing Address - Country:US
Mailing Address - Phone:313-829-6447
Mailing Address - Fax:
Practice Address - Street 1:1201 N MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4356
Practice Address - Country:US
Practice Address - Phone:313-829-6447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002825152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist