Provider Demographics
NPI:1215958996
Name:JUAREZ, NELSON (OD)
Entity type:Individual
Prefix:DR
First Name:NELSON
Middle Name:
Last Name:JUAREZ
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6477TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00396130OtherRAIL ROAD MEDICARE PTAN
TXV07297Medicare UPIN
TX8F1728Medicare PIN