Bruce D Nelson

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

BRUCE D NELSON

Doing business as

Pelican River Optical

Practice address

1131 Jackson Ave
Detroit Lakes, MN 56501-3618

Phone

(218) 847-5663

Fax

(218) 847-0964

NPI assigned

Mar 9, 2008

Last updated

Jul 16, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Bruce Donald Nelson

Title

Optician/Owner

Phone

(218) 847-5663

Specialties & licenses 1

Addresses

Other names 1

• Pelican River Optical Doing business as

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

{
    "created_epoch": "1205020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216166400000",
    "number": "1891965562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1131 JACKSON AVE",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565013618",
            "telephone_number": "218-847-5663",
            "fax_number": "218-847-0964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1131 JACKSON AVE",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565013618",
            "telephone_number": "218-847-5663",
            "fax_number": "218-847-0964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUCE D NELSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-09",
        "last_updated": "2008-07-16",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "DONALD",
        "authorized_official_title_or_position": "OPTICIAN/OWNER",
        "authorized_official_telephone_number": "218-847-5663",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pelican River Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gary L. Bowman, PH.D.
• Anders Bruce Braaten, APRN, CNP
• Tricia Rae Brein, MD
• Danielle Broden
• Hailey Brower, LICSW
• Nathan Brunken, MD
• Brooke Pella Bryant, NP
• Benjamin R Buntrock, DMD
• Isabella M Byer, DPT
• Teri Ellen Cain, LADC

• Eyewear Supplier in Detroit Lakes, MN
• Providers in Detroit Lakes, MN by specialty
• Eyewear Supplier in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2008; 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.