Stanley J Nelson, O.D.
Individual provider Active NPI Optometrist · Marysville, KS
NPI 1891736146 · NPPES record last updated Jul 11, 2007
Key facts
- NPI
- 1891736146
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 1124-3 (KS)
- Practice address
- 715 Broadway
Marysville, KS 66508-1841 - Phone
- (785) 562-2631
- Fax
- (785) 562-4006
- NPI assigned
- Jun 9, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kurt R. Olson, OD LLC | Optometrist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1124-3 | KS | Yes |
| Corneal and Contact Management Optometrist | 152WC0802X | 1124-3 | KS | |
| Low Vision Rehabilitation Optometrist | 152WL0500X | 1124-3 | KS | |
| Occupational Vision Optometrist | 152WX0102X | 1124-3 | KS |
Addresses
Primary practice location
715 Broadway
Marysville, KS 66508-1841
Mailing address
715 Broadway
Marysville, KS 66508-1841
Phone (785) 562-2631
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100250616-00 | Medicaid | NE | |
| 0000005204 | Other | KS | BLUE CROSS & BLUE SHIELD |
Other providers in Marysville, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 11, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.