Healthcare Provider Details

I. General information

NPI: 1922366327
Provider Name (Legal Business Name): NIELSON EYE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2316 EASTGATE ST STE 170
WALLA WALLA WA
99362-1576
US

IV. Provider business mailing address

2316 EASTGATE ST STE 170
WALLA WALLA WA
99362-1576
US

V. Phone/Fax

Practice location:
  • Phone: 509-529-7371
  • Fax: 509-529-7379
Mailing address:
  • Phone: 509-529-7371
  • Fax: 509-529-7379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3519WA
License Number StateWA

VIII. Authorized Official

Name: BRADLEY NIELSON
Title or Position: OWNER/PRES
Credential: OD
Phone: 509-529-7371