MEDICARE: BRANDEE NELSON OD

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	3639	TN
2	152W00000X	Optometrist	4901005858	MI
3	152W00000X	Optometrist	2668	NC

General Provider Information

NPI Number	:	1639788961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDEE NELSON OD

Provider Business Mailing Address
First Line	:	41555 W TWELVE MILE RD
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48377-3103
Country	:	US
Telephone Number	:	248-675-0800
Fax Number	:	248-675-0545

Provider Business Practice Location Address
First Line	:	41555 W TWELVE MILE RD
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48377-3103
Country	:	US
Telephone Number	:	248-675-0800
Fax Number	:	248-675-0545

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

Provider Enumeration Date	:	07/22/2020
Last Update Date	:	10/13/2025

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Directions to “ BRANDEE NELSON OD” Practice Location

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