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General NPI Number Information
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NPI Number | 1124352588
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Entity Type | Organization
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Legal Business Name | NIELSEN OPTICAL, PC
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Dates
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Enumeration Date | 10/01/2009
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Last Update Date | 12/04/2009
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Provider Practice Location Address
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Address Line | 2200 GREENGATE CENTRE WAL-MART VISION CENTER
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City | GREENSBURG
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State | PA
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Zip | 15601
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Country | US
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Telephone | 724-830-2452
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Fax |
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Provider Business Mailing Address
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Address Line | 482 AUSTRAW RD
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City | LIGONIER
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State | PA
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Zip | 15658-2489
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Country | US
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Telephone | 724-238-0402
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | MELISSA NIELSEN ROST
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Credential | O.D.
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Telephone | 724-238-0402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | OET009008
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License Number State | PA
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