Provider Demographics
NPI:1295715241
Name:NELSON, MARC (OD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:
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 1:55 CAMEO DR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-5127
Mailing Address - Country:US
Mailing Address - Phone:856-424-5611
Mailing Address - Fax:
Practice Address - Street 1:185 N ROUTE 73
Practice Address - Street 2:
Practice Address - City:WEST BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08091-9208
Practice Address - Country:US
Practice Address - Phone:856-767-5033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4802152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0834480000OtherAMERIHEALTH
NJJ023980OtherTRICARE
NJ01000670400OtherAMERICHOICE
NJ2K0196OtherHEALTHNET
NJ5223407Medicaid
NJ451960OtherAETNA
NJU33424Medicare UPIN
NJJ023980OtherTRICARE