Jared Nelson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

8684413-9934 Issued in UT

Practice address

Unit 28130 Box Usahc
Apo, AE 09114-8130

Phone

(314) 590-3207

NPI assigned

Jun 1, 2013

Last updated

Oct 27, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wasatch Vision Clinic LLC

  • Optometrist
  • Salt Lake City, UT
  • NPI 1255517637
  NPD
• Mountain West Eyecare Inc

  • Optometrist
  • West Valley City, UT
  • NPI 1174708663
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1370044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698364800000",
    "number": "1518304435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "681 S GRANT LN",
            "city": "NORTH SALT LAKE",
            "state": "UT",
            "postal_code": "840541204",
            "telephone_number": "435-720-3280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "MIL",
            "address_1": "UNIT 28130 BOX USAHC",
            "city": "APO",
            "state": "AE",
            "postal_code": "091148130",
            "telephone_number": "314-590-3207"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "849 E 400 S",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841022928",
            "country_code": "US",
            "telephone_number": "018-328-2020",
            "fax_number": "801-363-2201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NELSON",
        "first_name": "JARED",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-01",
        "last_updated": "2023-10-27",
        "certification_date": "2023-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD60401345",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "8684413-9934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.