Provider Demographics
NPI:1386310787
Name:NELSEN, EMILY (OD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:NELSEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:15704 90TH ST NE # 100
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55330-7448
Mailing Address - Country:US
Mailing Address - Phone:763-241-1090
Mailing Address - Fax:763-241-1091
Practice Address - Street 1:13889 RIDGEDALE DR
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1768
Practice Address - Country:US
Practice Address - Phone:763-241-1090
Practice Address - Fax:763-241-1091
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAOD61166966152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist