Organization
NELSON EYECARE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENJAMIN B NELSON O.D. (PRESIDENT)
(660) 826-3490
Entity
Organization
Contact information
Practice address
3201 W BROADWAY BLVD, SEDALIA, MO 65301-2118
(660) 826-0683
Mailing address
2015 HEDGE APPLE DR, SEDALIA, MO 65301-8986
(660) 826-3490
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2001018945
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P590000
MEDICARE GROUP PROVIDER #
MO
Enumeration date
09/19/2007
Last updated
09/19/2007
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