BRUCE D NELSON NPI 1891965562

NPI Information

  • NPI: 1891965562
  • Provider Name: BRUCE D NELSON
  • Classification: Eyewear Supplier - 332H00000X
  • Entity Type: Organization
  • Doing Business As: PELICAN RIVER OPTICAL
  • Address: 1131 JACKSON AVE
    DETROIT LAKES, MN
    ZIP 56501
  • Phone: (218) 847-5663

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NPI Details

BRUCE D NELSON is an eyewear supplier in Detroit Lakes, MN. The provider is an organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. BRUCE D NELSON NPI is 1891965562. The provider is registered as an organization entity type.
The provider Is Doing Business As Pelican River Optical.

The provider's business location address is:

1131 JACKSON AVE
DETROIT LAKES, MN
ZIP 56501-618
Phone: (218) 847-5663
Fax: (218) 847-0964

The provider's authorized official is Bruce Donald Nelson .
The authorized official title is Optician/owner and has the following contact phone number (218) 847-5663.

The enumeration date for this NPI number is 3/9/2008 and was last updated on 7/16/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1332H00000XEyewear SupplierYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
10181390001MEDICARE NSCMINNESOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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