Provider Demographics
NPI:1386712867
Name:NELSON, VONNIE KAY (OD)
Entity type:Individual
Prefix:
First Name:VONNIE
Middle Name:KAY
Last Name:NELSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-1352
Mailing Address - Country:US
Mailing Address - Phone:507-931-6436
Mailing Address - Fax:507-934-9625
Practice Address - Street 1:320 SUNRISE DR
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-1352
Practice Address - Country:US
Practice Address - Phone:507-931-6436
Practice Address - Fax:507-934-9625
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2447152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1027073OtherPREFERRED ONE
MN21 16066OtherMEDICA EYEWEAR
MN126T3NEOtherBCBS
IA0716373OtherIOWA MEDICAID
MN141695OtherUCARE
MN0322460001OtherDMERC
MNHP21215OtherHEALTH PARTNERS
MN2202077OtherMEDICA
MN44977THOtherBLUEPLUS EYEWEAR
MN2202077OtherMEDICA
MN1027073OtherPREFERRED ONE