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Individual

MR. DANIEL A NIELSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
611 W PARK ST, OPTOMETRY, URBANA, IL 61801-2500
(217) 383-3150
(217) 383-4845
Mailing address
611 W PARK ST, BWPC, URBANA, IL 61801
(217) 383-4752

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046009298
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
410043693
PALMETTO GBA
Enumeration date
01/22/2007
Last updated
08/20/2016
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