Provider Demographics
NPI:1285792663
Name:NELSON, CHARLES L (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
Last Name:NELSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5235 B WALZEM
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-2122
Mailing Address - Country:US
Mailing Address - Phone:210-657-2020
Mailing Address - Fax:210-657-2028
Practice Address - Street 1:5235 B WALZEM
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-2122
Practice Address - Country:US
Practice Address - Phone:210-657-2020
Practice Address - Fax:210-657-2028
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX2272152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
17473OtherSPECTERA
27975OtherAVESIS
00940EMedicare ID - Type Unspecified