Provider Demographics
NPI:1083897342
Name:NELSON JUAREZ, O.D., P.A.
Entity type:Organization
Organization Name:NELSON JUAREZ, O.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:JUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-331-8681
Mailing Address - Street 1:2800 S GORDON ST
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-4731
Mailing Address - Country:US
Mailing Address - Phone:281-331-8681
Mailing Address - Fax:281-585-4582
Practice Address - Street 1:2800 S GORDON ST
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-4731
Practice Address - Country:US
Practice Address - Phone:281-331-8681
Practice Address - Fax:281-585-4582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6477TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00811ZMedicare PIN