Organization
NELSON NELSON NELSON OD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY LAYNE NELSON OD (OWNER)
(580) 623-5073
Entity
Organization
Contact information
Practice address
203 N NOBLE AVE, WATONGA, OK 73772-0590
(580) 623-5073
(580) 623-5020
Mailing address
203 N NOBLE AVE, WATONGA, OK 73772-0590
(580) 623-5073
(580) 623-5020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1011
OK
332H00000X
Eyewear Supplier
1011
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100768490B
—
OK
Enumeration date
09/01/2006
Last updated
02/11/2014
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