Healthcare Provider Details

I. General information

NPI: 1942331145
Provider Name (Legal Business Name): OMAHA PRIMARY EYE CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 S 180TH ST
ELKHORN NE
68022-7044
US

IV. Provider business mailing address

1011 S 180TH ST
ELKHORN NE
68022-7044
US

V. Phone/Fax

Practice location:
  • Phone: 402-330-3000
  • Fax: 402-330-2166
Mailing address:
  • Phone: 402-330-3000
  • Fax: 402-330-2166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1022
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1024
License Number StateNE

VIII. Authorized Official

Name: MICHAEL SKRADIS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 402-330-3000