Healthcare Provider Details

I. General information

NPI: 1154335065
Provider Name (Legal Business Name): EYECARE SPECIALTIES, PC OF LINCOLN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 N BELL ST
FREMONT NE
68025-3534
US

IV. Provider business mailing address

PO BOX 72
FREMONT NE
68026-0072
US

V. Phone/Fax

Practice location:
  • Phone: 402-727-9220
  • Fax: 402-727-5625
Mailing address:
  • Phone: 402-727-9050
  • Fax: 402-727-5625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number786
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number780
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: KATIE REMINGTON
Title or Position: BILLING DEPARTMENT
Credential:
Phone: 402-420-2020