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General NPI Number Information
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NPI Number | 1609918390
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Entity Type | Organization
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Legal Business Name | DAVID A NELSON OD PA LLC
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 02/15/2012
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Provider Practice Location Address
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Address Line | 4123 SW GAGE CENTER DR SUITE 126
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City | TOPEKA
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State | KS
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Zip | 66604-1886
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Country | US
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Telephone | 785-273-6717
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Fax | 785-228-2029
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Provider Business Mailing Address
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Address Line | 4123 SW GAGE CENTER DR SUITE 126
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City | TOPEKA
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State | KS
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Zip | 66604-1886
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Country | US
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Telephone | 785-273-6717
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Fax | 785-228-2029
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Authorized Official
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Title or Position | OWNER
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Name | DAVID A NELSON
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Credential | OD
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Telephone | 785-273-6717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1357-3
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License Number State | KS
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