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Individual

MR. GARY H NELSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
OPTICIAN

Contact information

Practice address
707 FAIRMOUNT AVE, SUITE 11, JAMESTOWN, NY 14701-2623
(716) 483-1955
Mailing address
707 FAIRMOUNT AVE., STE 11, JAMESTOWN, NY 14701-2623
(716) 483-1955

Taxonomy

Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
004127-1
NY
332B00000X
Durable Medical Equipment & Medical Supplies
4127-1
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00622124
NY
Enumeration date
12/05/2006
Last updated
11/03/2011
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