Individual
DR. STANLEY J NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
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
152W00000X
Optometrist
Primary
1124-3
KS
152WC0802X
Corneal and Contact Management Optometrist
1124-3
KS
152WL0500X
Low Vision Rehabilitation Optometrist
1124-3
KS
152WX0102X
Occupational Vision Optometrist
1124-3
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000005204
BLUE CROSS & BLUE SHIELD
KS
05
—
100250616-00
—
NE
Enumeration date
06/09/2006
Last updated
07/11/2007
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