Provider Demographics
NPI:1841302700
Name:NELSON, JAMES (OD)
Entity type:Individual
Prefix:
First Name:JAMES
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:PO BOX 948
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-0948
Mailing Address - Country:US
Mailing Address - Phone:605-352-4181
Mailing Address - Fax:605-352-4189
Practice Address - Street 1:1288 DAKOTA AVE S STE 3
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-3675
Practice Address - Country:US
Practice Address - Phone:605-352-4181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDT112152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9201065Medicaid
SD0041041OtherWELLMARK BCBS OF SD
SD0041041OtherWELLMARK BCBS OF SD
SDT78829Medicare UPIN