KELLY H NILSSON, OD, PA (NPI# 1578815742) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578815742 |
| Entity Type | Organization |
| Organization Name | KELLY H NILSSON, OD, PA |
| Other Organization Name | NILSSON EYE CARE |
| Practice Address |
2011 Highway 280 Byp Phenix City AL 36867-3624 |
| Mailing Address |
320 Steele Creek Dr Midland GA 31820-4647 |
| Practice Telephone | 3344804015 |
| Mailing Telephone | 6013471725 |
| Mailing Fax Number | 7066823931 |
| Enumeration Date | 2012-10-11 |
| Last Update Date | 2019-07-15 |
| Authorized Official Name | DR. KELLY HONSINGER NILSSON (PRESIDENT) |
| Authorized Official Telephone | 6013471725 |
| Authorized Official Credential | OD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 152W00000X | Optometrist | 4662 | FL | Eye and Vision Services Providers |
| N | 152W00000X | Optometrist | OPT002997 | GA | Eye and Vision Services Providers |
| N | 152W00000X | Optometrist | 842 | MS | Eye and Vision Services Providers |
| N | 152W00000X | Optometrist | AL | Eye and Vision Services Providers | |
| Y | 152W00000X | Optometrist | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| HUMANA VCP | A10819 | 01 | |
| EYEMED | A10819 | 01 |
| Other Name | Type Code |
|---|---|
| Nilsson Eye Care | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2011 Highway 280 Byp, Phenix City, AL 368673624 | 3344804015 | |
| 2501 Whittlesey Blvd Ste A, Columbus, GA 319093032 | 7065079391 | 7065073929 |
| 3107 Pga Blvd, Palm Beach Gardens, FL 334102801 | 5616252829 | 5616252830 |
| 9220 Marne Rd, Fort Benning, GA 319055515 | 7066823938 | 7066823938 |
| Street Address |
2011 HIGHWAY 280 BYP |
| City | PHENIX CITY |
| State | AL |
| Zip Code | 36867-3624 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164934360 | Grady W Stone Jr. | Technician/Technologist | 2011 Highway 280 Byp, Phenix City, AL 36867-3624 | 2017-10-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316576986 | Victoria Martinec | Dental Hygienist | 3732 Us Hwy 280, Phenix City, AL 36867 | 2020-04-06 |
| 1255993390 | Alexa Paige Jones | Family Medicine | 3700 Ste A S Railroad St, Phenix City, AL 36867 | 2019-06-28 |
| 1548755150 | David Thompson | Student in an Organized Health Care Education/Training Program | 4401 Riverchase Dr., Phenix City, AL 36867 | 2018-06-26 |
| 1134613714 | Sarah Uehara Yee | Dentist | 3732 Hwy 280 Bypass, Phenix City, AL 36867 | 2018-06-18 |
| 1770074676 | James L Pridgen IIi | Registered Nurse | 1533 Summerplace Dr, Phenix City, AL 36867 | 2018-05-25 |
| 1598288219 | Rachelle Moliere | Nurse Practitioner | 4402 Riverchase Drive, #4301, Phenix City, AL 36867 | 2017-07-25 |
| 1417477852 | Devin William Collins | Orthopaedic Surgery | 4401 River Chase Drive, Phenix City, AL 36867 | 2017-06-27 |
| 1770003774 | Tabatha Yvette Jones | Registered Nurse | 506 Lee Rd 554, Phenix City, AL 36867 | 2017-06-21 |
| 1134659030 | Jack Clifford Golden Jr. | Pharmacist | 3700 Us Hwy 280/431n, Phenix City, AL 36867 | 2017-06-14 |
| 1386098440 | Mudassar Khan | Orthopaedic Surgery | 4401 Riverchase Dr, Phenix City, AL 36867 | 2016-04-14 |
| Find all providers in zip 36867 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457657785 | Melanie Denton | Optometrist | 5009 Riverchase Dr Ste 400b, Phenix City, AL 36867-7520 | 2011-02-03 |
| 1467559088 | Jonathan Guy Harp | Optometrist | 3700 Highway 431 N, Phenix City, AL 36867-2362 | 2006-09-17 |
| 1578590733 | Eye Lab Vision Center, Inc. | Optometrist | 2011 Highway 280 Bypass, Phenix City, AL 36867 | 2006-06-26 |
| 1881726305 | R. Griff Gordy PC | Optometrist | 5009 River Chase Dr, Building 100 Suite B, Phenix City, AL 36867-7425 | 2007-03-10 |
| 1396776845 | Richard G Gordy | Optometrist | 5009 River Chase Dr, Bldg 100 Suite C, Phenix City, AL 36867-7425 | 2006-07-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487252920 | Pelham Eye Center LLC | Optometrist | 200 Canyon Park Dr, Pelham, AL 35124-4817 | 2020-10-16 |
| 1497360002 | Ian Maisonville | Optometrist | 3017 Indian Crest Dr, Pelham, AL 35124-4701 | 2020-09-10 |
| 1295340172 | National Vision Inc | Optometrist | 1107 Beltline Rd Se Ste C, Decatur, AL 35601-6556 | 2020-09-09 |
| 1417560418 | Blue Vision Center LLC | Optometrist | 2818 Lakeshore Pkwy, Birmingham, AL 35211-5500 | 2020-08-28 |
| 1932727120 | Justin Michael Kendall | Optometrist | 5850 A Us Hwy 431, Albertville, AL 35950 | 2020-07-14 |
| 1457978504 | Sadiksha Prasain | Optometrist | 616 Northmoor Ln, Homewood, AL 35209-6422 | 2020-07-05 |
| 1447875919 | Brookstone Optical LLC | Optometrist | 4760 Eastern Valley Rd Ste 132, Mc Calla, AL 35111-3460 | 2020-06-10 |
| 1952926776 | Mason Buckley Childers | Optometrist | 6020 Boll Weevil Cir, Enterprise, AL 36330-9420 | 2020-06-09 |
| 1023630985 | Southern Vision Eye Care | Optometrist | 308 6th St S Ste 105, Oneonta, AL 35121-1842 | 2020-05-14 |
| 1033745773 | Ashley Ott Od LLC | Optometrist | 21530 Professional Dr Ste D, Robertsdale, AL 36567-9911 | 2020-03-13 |
| Find all providers with the same taxonomy | ||||
| City | PHENIX CITY |
| Zip Code | 36867 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.