Provider Demographics
NPI:1487785499
Name:NELSON, JARROD ALLEN (OD)
Entity type:Individual
Prefix:DR
First Name:JARROD
Middle Name:ALLEN
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 1:1479 485TH ST W
Mailing Address - Street 2:
Mailing Address - City:STANCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55080-4216
Mailing Address - Country:US
Mailing Address - Phone:763-691-8252
Mailing Address - Fax:
Practice Address - Street 1:5366 386TH ST NE
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-5833
Practice Address - Country:US
Practice Address - Phone:651-674-6844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2410152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN159371OtherEYEMED
MN22-02649OtherMEDICA
MN817S9NEOtherBLUE CROSS BLUE SHIELD
MNHP28522OtherHEALTH PARTNERS
MN552025800Medicaid
MN916771028513OtherPREFERRED ONE