Provider Demographics
NPI:1366288219
Name:NEBELSICK OPTOMETRIC PLLC
Entity type:Organization
Organization Name:NEBELSICK OPTOMETRIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:NEBELSICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:605-999-0152
Mailing Address - Street 1:23811 KIEFFER RANCH RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-7369
Mailing Address - Country:US
Mailing Address - Phone:605-999-0152
Mailing Address - Fax:605-348-6694
Practice Address - Street 1:409 KANSAS CITY ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3636
Practice Address - Country:US
Practice Address - Phone:605-348-2323
Practice Address - Fax:605-348-6694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty