Provider Demographics
NPI:1134246564
Name:NELSON, ERIK LESLIE (OD)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:LESLIE
Last Name:NELSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 WAINEE ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-2321
Mailing Address - Country:US
Mailing Address - Phone:808-661-3686
Mailing Address - Fax:808-661-3687
Practice Address - Street 1:845 WAINEE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-2321
Practice Address - Country:US
Practice Address - Phone:808-661-3686
Practice Address - Fax:808-661-3687
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI111152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI051490Medicaid
HIH0000PCBMDMedicare ID - Type Unspecified