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General NPI Number Information
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NPI Number | 1639788961
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Entity Type | Individual
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Provider Name | BRANDEE NELSON OD
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Gender | Female
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Dates
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Enumeration Date | 07/22/2020
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 41555 W TWELVE MILE RD
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City | NOVI
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State | MI
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Zip | 48377-3103
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Country | US
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Telephone | 248-675-0800
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Fax | 248-675-0545
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Provider Business Mailing Address
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Address Line | 41555 W TWELVE MILE RD
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City | NOVI
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State | MI
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Zip | 48377-3103
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Country | US
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Telephone | 248-675-0800
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Fax | 248-675-0545
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3639
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901005858
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License Number State | MI
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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 | 2668
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License Number State | NC
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