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General NPI Number Information
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NPI Number | 1770952863
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Entity Type | Organization
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Legal Business Name | NIELSEN VISION DEVELOPMENT CENTER
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 09/18/2015
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Provider Practice Location Address
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Address Line | 9330 CORPORATE DR SUITE 702
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City | SELMA
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State | TX
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Zip | 78154-1251
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Country | US
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Telephone | 210-590-2485
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 918
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City | SCHERTZ
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State | TX
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Zip | 78154-0918
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Country | US
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Telephone | 832-385-8735
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LEIGHA MISHELLE NIELSEN
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Credential | O.D.
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Telephone | 210-590-2485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WS0006X
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Taxonomy Name | Sports Vision Optometrist
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License Number | 7776TG
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 7776TG
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 152WX0102X
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Taxonomy Name | Occupational Vision Optometrist
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License Number | 7776TG
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License Number State | TX
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