Provider Demographics
NPI:1770952863
Name:NIELSEN VISION DEVELOPMENT CENTER
Entity type:Organization
Organization Name:NIELSEN VISION DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEIGHA
Authorized Official - Middle Name:MISHELLE
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-590-2485
Mailing Address - Street 1:PO BOX 918
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-0918
Mailing Address - Country:US
Mailing Address - Phone:832-385-8735
Mailing Address - Fax:
Practice Address - Street 1:9330 CORPORATE DR
Practice Address - Street 2:SUITE 702
Practice Address - City:SELMA
Practice Address - State:TX
Practice Address - Zip Code:78154-1251
Practice Address - Country:US
Practice Address - Phone:210-590-2485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7776TG152WS0006X, 152WX0102X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Single Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Single Specialty