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General NPI Number Information
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NPI Number | 1861527046
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Entity Type | Individual
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Provider Name | STEVEN EDWARD NELSON O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2000 US HWY 181
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City | PORTLAND
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State | TX
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Zip | 78374
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Country | US
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Telephone | 361-777-3400
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Fax | 341-777-3410
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Provider Business Mailing Address
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Address Line | 1210 MEADOW BROOK DR
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City | PORTLAND
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State | TX
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Zip | 78374-4157
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Country | US
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Telephone | 361-777-3400
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Fax | 361-777-3410
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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 | 5992TG
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License Number State | TX
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