Provider Demographics
NPI:1861579070
Name:NELSON, DIANE J (OD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:J
Last Name:NELSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:55 CRYSTAL AVE
Mailing Address - Street 2:HOOD COMMONS
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-1702
Mailing Address - Country:US
Mailing Address - Phone:603-434-2020
Mailing Address - Fax:603-437-1260
Practice Address - Street 1:55 CRYSTAL AVE
Practice Address - Street 2:HOOD COMMONS
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-1702
Practice Address - Country:US
Practice Address - Phone:603-434-2020
Practice Address - Fax:603-437-1260
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH0499152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE0929Medicare PIN
NHT91887Medicare UPIN