Healthcare Provider Details

I. General information

NPI: 1235791104
Provider Name (Legal Business Name): EYECONIC VISION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11844 STANDING STONE DR STE 100
GRETNA NE
68028-7979
US

IV. Provider business mailing address

18814 BRIAR ST
OMAHA NE
68136-1626
US

V. Phone/Fax

Practice location:
  • Phone: 402-687-3435
  • Fax:
Mailing address:
  • Phone: 308-940-0876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. CATHLEEN ROARK
Title or Position: OWNER
Credential: OD
Phone: 402-687-3435