Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO2430 | FL |
NPI | 1225088024 |
---|---|
Provider Name | Jeffrey A Nelson |
First Address | Lake Worth, FL 33467-2529 |
Second Address | Lake Worth, FL 33467-2529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 07/01/2008 |