Active NPI
Timothy L Nelson, OD
- Optometrist
- Watonga, OK
National Provider Identifier
1720058654
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1011
- Practice address
- 203 N Noble Ave
Watonga, OK 73772-0590 - Phone
- (580) 623-5073
- Fax
- (580) 623-5020
- NPI assigned
- Jan 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1011 | OK | Primary |
Addresses
Primary practice location
203 N Noble Ave
Watonga, OK 73772-0590
Mailing address
203 N Noble Ave
Watonga, OK 73772-0590
Phone (580) 623-5073
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 730989130001 | Other | OK | BCBS PROVIDER NUMBER |
| 100761510A | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1011 | OK | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358121600000",
"number": "1720058654",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "203 N NOBLE AVE",
"city": "WATONGA",
"state": "OK",
"postal_code": "737720590",
"telephone_number": "580-623-5073",
"fax_number": "580-623-5020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "203 N NOBLE AVE",
"city": "WATONGA",
"state": "OK",
"postal_code": "737720590",
"telephone_number": "580-623-5073",
"fax_number": "580-623-5020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "TIMOTHY",
"middle_name": "L",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-24",
"last_updated": "2013-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OK",
"license": "1011",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER NUMBER",
"identifier": "730989130001",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100761510A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Watonga, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.