Provider Demographics
NPI:1770592628
Name:NELSON, DAVID LAND (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LAND
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 1:2306 E END BLVD S
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75672-7469
Mailing Address - Country:US
Mailing Address - Phone:903-938-2555
Mailing Address - Fax:903-938-1011
Practice Address - Street 1:2306 E END BLVD S
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75672-7469
Practice Address - Country:US
Practice Address - Phone:903-938-2555
Practice Address - Fax:903-938-1011
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1923TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX316319801Medicaid
TX121648304Medicaid
TX0891290001Medicare NSC
T15013Medicare UPIN
TXP00638269Medicare PIN
TX121648304Medicaid
TX410012562Medicare PIN