Healthcare Provider Details

I. General information

NPI: 1861626806
Provider Name (Legal Business Name): RETINA CENTER OF NEBRASKA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6003 OSBORNE DR W
HASTINGS NE
68901-9160
US

IV. Provider business mailing address

2115 N KANSAS AVE STE 104
HASTINGS NE
68901-2615
US

V. Phone/Fax

Practice location:
  • Phone: 402-461-4611
  • Fax: 402-461-4616
Mailing address:
  • Phone: 402-461-4611
  • Fax: 402-461-4616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number15430
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number15430
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number28285
License Number StateNE
# 4
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN C WELCH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 402-461-4611