Provider Demographics
NPI:1164222949
Name:CHANG VELAZQUEZ, NELSON DANIEL
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:DANIEL
Last Name:CHANG VELAZQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 FABIANNA DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-2897
Mailing Address - Country:US
Mailing Address - Phone:865-296-8399
Mailing Address - Fax:
Practice Address - Street 1:2020 HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-2000
Practice Address - Country:US
Practice Address - Phone:254-699-4721
Practice Address - Fax:254-699-4783
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician