Healthcare Provider Details

I. General information

NPI: 1346165818
Provider Name (Legal Business Name): THORNTONKRUEGER RE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19303 S HWS CLEVELAND BLVD
ELKHORN NE
68022
US

IV. Provider business mailing address

16303 PAGE ST
OMAHA NE
68118-2515
US

V. Phone/Fax

Practice location:
  • Phone: 708-623-8214
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: IVEY L THORNTON
Title or Position: OWNER
Credential: MD
Phone: 303-990-6262