Organization
DR. STANLEY J. NELSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STANLEY J NELSON O.D. (OPTOMETRIST/OWNER)
(785) 562-2631
Entity
Organization
Contact information
Practice address
715 BROADWAY, MARYSVILLE, KS 66508-1841
(785) 562-2631
(785) 562-4006
Mailing address
715 BROADWAY, MARYSVILLE, KS 66508-1841
(785) 562-2631
(785) 562-4006
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
1124-3
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000005204
BLUE CROSS/BLUE SHIELD
KS
01
—
005204
MEDICARE
KS
05
—
100250616-00
—
NE
Enumeration date
10/24/2007
Last updated
10/24/2007
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