Healthcare Provider Details

I. General information

NPI: 1225497837
Provider Name (Legal Business Name): EYE CARE SPECIALTIES PC OF LINCOLN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 ELK LN
FREMONT NE
68025-8696
US

IV. Provider business mailing address

7930 O ST
LINCOLN NE
68510-2500
US

V. Phone/Fax

Practice location:
  • Phone: 402-420-2020
  • Fax: 402-323-2002
Mailing address:
  • Phone: 402-420-2020
  • Fax: 402-323-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberNE
License Number State

VIII. Authorized Official

Name: ANDREA S TUNINK
Title or Position: BILLING DEPARTMENT
Credential:
Phone: 402-420-2020