MEDICARE: SCOTT THOMAS NILSSON O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	0618001752	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1427498344	OTHER	VA	GROUP NPI

General Provider Information

NPI Number	:	1215198668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT THOMAS NILSSON O.D.

Provider Business Mailing Address
First Line	:	2000 GENERAL BOOTH BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-5876
Country	:	US
Telephone Number	:	575-426-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 GENERAL BOOTH BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-5876
Country	:	US
Telephone Number	:	575-426-2020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2008
Last Update Date	:	03/17/2015

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