Healthcare Provider Details

I. General information

NPI: 1760232466
Provider Name (Legal Business Name): KAYLEIGH NELSON OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 SW PINE ISLAND RD UNIT 102
CAPE CORAL FL
33991-2053
US

IV. Provider business mailing address

706 SW PINE ISLAND RD UNIT 102
CAPE CORAL FL
33991-2053
US

V. Phone/Fax

Practice location:
  • Phone: 239-451-5954
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14290414-9934
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7022
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: