Provider Demographics
NPI:1770695371
Name:NELSEN EYECARE INC
Entity type:Organization
Organization Name:NELSEN EYECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:NELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-762-0689
Mailing Address - Street 1:6N467 E RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-6286
Mailing Address - Country:US
Mailing Address - Phone:630-762-0689
Mailing Address - Fax:847-468-9779
Practice Address - Street 1:1100 S RANDALL RD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4109
Practice Address - Country:US
Practice Address - Phone:847-468-9777
Practice Address - Fax:847-468-1557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008742152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046008742Medicaid
IL03419OtherPROVIDER NUMBER
IL03419OtherPROVIDER NUMBER
IL259910Medicare ID - Type Unspecified