Individual
BENNETT W NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
206 DIVISION ST, WAITE PARK, MN 56387-1331
(320) 253-0365
(320) 253-9401
Mailing address
206 DIVISION ST, WAITE PARK, MN 56387-1331
(320) 253-0365
(320) 253-9401
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3091
MN
152W00000X
Optometrist
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
453K2NE
BLUE CROSS
MN
01
—
HP82012
HEALTH PARTNERS
—
01
—
XX0531051795
PREFERRED ONE
MN
Enumeration date
12/06/2006
Last updated
11/30/2007
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