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Organization
NELSON & ENDICOTT AN OPTOMETRIC CORPORATION
Active
Organization
NELSON & ENDICOTT AN OPTOMETRIC CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN C NELSON O.D. (OWNER)
(626) 961-0877
Entity
Organization
Contact information
Practice address
15909 MAIN ST, LA PUENTE, CA 91744-4720
(626) 961-0877
(909) 468-4603
Mailing address
15909 MAIN ST, LA PUENTE, CA 91744-4720
(626) 961-0877
(909) 468-4603
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
6093T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GSD001241
—
CA
Enumeration date
01/31/2006
Last updated
09/01/2009
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