Individual
RICHARD A NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2205 HARRISON ROAD, WAL-MART VISION CENTER, THOMSON, GA 30824
(706) 595-9534
(706) 595-6512
Mailing address
PO BOX 5721, ATTN: ADMINISTRATOR, COLUMBIA, SC 29250
(803) 779-2273
(803) 799-0854
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1032
SC
152W00000X
Optometrist
Primary
OPT001682
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20047638
SELECT HEALTH OF SC
SC
05
—
D10325
—
SC
Enumeration date
06/27/2006
Last updated
07/08/2007
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