Provider Demographics
NPI:1861458176
Name:NELSEN, STEVEN J (OD)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:J
Last Name:NELSEN
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 1:16800 WEST CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-3533
Mailing Address - Country:US
Mailing Address - Phone:262-432-2005
Mailing Address - Fax:
Practice Address - Street 1:2229 S MEMORIAL PL
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3715
Practice Address - Country:US
Practice Address - Phone:920-458-9301
Practice Address - Fax:920-458-9302
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2509152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2509OtherEYEMED VISION NO.
WI38587100Medicaid
WI38587100Medicaid