Healthcare Provider Details

I. General information

NPI: 1669585196
Provider Name (Legal Business Name): MIDWEST EYE CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2827 N CLARKSON ST
FREMONT NE
68025-7714
US

IV. Provider business mailing address

2827 N CLARKSON ST
FREMONT NE
68025-7714
US

V. Phone/Fax

Practice location:
  • Phone: 402-721-7222
  • Fax: 402-721-2473
Mailing address:
  • Phone: 402-721-7222
  • Fax: 402-721-2473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number15441
License Number StateNE

VIII. Authorized Official

Name: CALLA PAPPAS
Title or Position: HR MANAGER
Credential:
Phone: 402-552-2020