MEDICARE: HEARTLAND OPTICAL INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1186	NE

General Provider Information

NPI Number	:	1588699318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND OPTICAL INC.

Provider Business Mailing Address
First Line	:	1012 N. 27TH ST.
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68503-1802
Country	:	US
Telephone Number	:	402-476-3311
Fax Number	:	402-476-0157

Provider Business Practice Location Address
First Line	:	1012 N. 27TH ST.
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68503-1802
Country	:	US
Telephone Number	:	402-476-3311
Fax Number	:	402-476-0157

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	MS. ANDRIA N LOUIS
Credential	:	O.D.
Telephone Number	:	402-476-3311

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	11/13/2008

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Directions to “HEARTLAND OPTICAL INC. ” Practice Location

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