Organization
NELSEN EYECARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARIA JEAN NELSEN O.D. (OPTOMETRIST)
(630) 762-0689
Entity
Organization
Contact information
Practice address
1100 S RANDALL RD, ELGIN, IL 60123-4109
(847) 468-9777
(847) 468-1557
Mailing address
6N467 E RIDGEWOOD DR, ST CHARLES, IL 60175-6286
(630) 762-0689
(847) 468-9779
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-008742
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03419
PROVIDER NUMBER
IL
05
—
046008742
—
IL
Enumeration date
08/31/2006
Last updated
01/04/2012
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