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Individual

TIMOTHY L NELSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

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

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100761510A
OK
01
730989130001
BCBS PROVIDER NUMBER
OK
Enumeration date
01/24/2006
Last updated
01/14/2013
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