Provider Demographics
NPI:1699774927
Name:NELSON, DAVID A (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:NELSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4123 SW GAGE CENTER DR
Mailing Address - Street 2:SUITE #126
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1886
Mailing Address - Country:US
Mailing Address - Phone:785-273-6717
Mailing Address - Fax:785-228-2029
Practice Address - Street 1:4123 SW GAGE CENTER DR
Practice Address - Street 2:SUITE #126
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1886
Practice Address - Country:US
Practice Address - Phone:785-273-6717
Practice Address - Fax:785-228-2029
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13573152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS600290OtherFIRST GUARD
KS410044216OtherRR MEDICARE
KS100219290BMedicaid
KS481216166OtherFEDERAL TAX ID
KS1278200001Medicare NSC
KS410044216OtherRR MEDICARE
KS100219290BMedicaid