MEDICARE: DR. MICHAEL NELL OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2624T	TX

General Provider Information

NPI Number	:	1578614475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL NELL OD

Provider Business Mailing Address
First Line	:	1148 W DALLAS ST
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77301-2208
Country	:	US
Telephone Number	:	936-756-8612
Fax Number	:	936-756-8603

Provider Business Practice Location Address
First Line	:	1148 W DALLAS ST
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77301-2208
Country	:	US
Telephone Number	:	936-756-8612
Fax Number	:	936-756-8603

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	01/20/2016

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