Provider Demographics
NPI:1538444799
Name:NELSON, NATALIE (OD)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 HAYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2744
Mailing Address - Country:US
Mailing Address - Phone:864-627-9500
Mailing Address - Fax:864-627-9325
Practice Address - Street 1:617 HAYWOOD RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2744
Practice Address - Country:US
Practice Address - Phone:864-627-9500
Practice Address - Fax:864-627-9325
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1681152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist