Provider Demographics
NPI:1538337985
Name:JOHN M. NEVELOW
Entity type:Organization
Organization Name:JOHN M. NEVELOW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:NEVELOW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-349-2437
Mailing Address - Street 1:19190 STONE OAK PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3237
Mailing Address - Country:US
Mailing Address - Phone:210-349-2437
Mailing Address - Fax:210-494-1633
Practice Address - Street 1:19190 STONE OAK PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3237
Practice Address - Country:US
Practice Address - Phone:210-349-2437
Practice Address - Fax:210-494-1633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2061TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherPROVIDER ID NUMBER
TXT15023Medicare UPIN
TX00E11HMedicare PIN
TX612180Medicare PIN
TX0360950001Medicare NSC
TX=========OtherPROVIDER ID NUMBER