MEDICARE: DR. DAVID LAND 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	1923TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770592628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID LAND NELSON OD

Provider Business Mailing Address
First Line	:	2306 E END BLVD S
Second Line	:
City	:	MARSHALL
State	:	TX
Zip	:	75672-7469
Country	:	US
Telephone Number	:	903-938-2555
Fax Number	:	903-938-1011

Provider Business Practice Location Address
First Line	:	2306 E END BLVD S
Second Line	:
City	:	MARSHALL
State	:	TX
Zip	:	75672-7469
Country	:	US
Telephone Number	:	903-938-2555
Fax Number	:	903-938-1011

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

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	05/10/2017

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