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General NPI Number Information
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NPI Number | 1447874060
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Entity Type | Individual
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Provider Name | KRISTIN NELSON OD, IACMM
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Gender | Female
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Dates
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Enumeration Date | 05/29/2020
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 11390 SUMMERLIN SQUARE DR
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City | FORT MYERS BEACH
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State | FL
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Zip | 33931-5300
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Country | US
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Telephone | 239-343-8880
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Fax | 239-343-4213
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Provider Business Mailing Address
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Address Line | PO BOX 2147
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City | FORT MYERS
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State | FL
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Zip | 33902-2147
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Country | US
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Telephone | 239-343-8880
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Fax | 239-343-4213
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 0466011423
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 046011423
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC6206
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046011423
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License Number State | IL
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