Individual
DALE E NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1234 GREELEY AVE N, GLENCOE, MN 55336-2103
(320) 864-6111
(320) 864-6134
Mailing address
4690 W ARM RD, SPRING PARK, MN 55384-9703
(952) 471-0562
(888) 770-8024
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1525
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040512010
METROPOLITAN HEALTH PLAN
—
01
—
12370NE
BCBS
—
01
—
22-02730
SELECT CARE
—
01
—
22-16206
MEDICA
—
01
—
2202730
MEDICA
—
05
—
602523400
—
MN
01
—
964661001450
PREFERRED ONE
—
Enumeration date
07/14/2005
Last updated
11/04/2009
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