Individual
TIMOTHY NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
11330 FOUNTAINS DR, MAPLE GROVE, MN 55369
(763) 494-8063
(763) 494-8062
Mailing address
720 N 4TH ST UNIT 704, MINNEAPOLIS, MN 55401-1950
(612) 743-1400
(763) 494-8062
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2827
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
048717100
—
MN
Enumeration date
12/20/2006
Last updated
12/11/2018
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