MEDICARE: DR. JONATHAN PAUL NEBELSICK 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	OD-980	HI
2	152W00000X	Optometrist	759	SD

General Provider Information

NPI Number	:	1659926160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN PAUL NEBELSICK OD

Provider Business Mailing Address
First Line	:	200 S CHICAGO ST
Second Line	:
City	:	HOT SPRINGS
State	:	SD
Zip	:	57747-2322
Country	:	US
Telephone Number	:	605-999-0152
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 S CHICAGO ST
Second Line	:
City	:	HOT SPRINGS
State	:	SD
Zip	:	57747-2322
Country	:	US
Telephone Number	:	605-745-3175
Fax Number	:	605-549-8170

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

Provider Enumeration Date	:	08/02/2019
Last Update Date	:	05/03/2024

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