Individual
DR. MICHAEL HENNEN NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
105 N YORK ST, MUSKOGEE, OK 74403-4657
(918) 682-2181
Mailing address
105 N YORK ST, MUSKOGEE, OK 74403-4657
(918) 682-2181
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
926
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100764840A
—
OK
Enumeration date
08/18/2005
Last updated
06/09/2008
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