Healthcare Provider Details

I. General information

NPI: 1841966066
Provider Name (Legal Business Name): EOL STUDIO 2, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 N 48TH STREET SUITE 103
LINCOLN NE
68504
US

IV. Provider business mailing address

308 N 48TH STREET SUITE 300
LINCOLN NE
68504
US

V. Phone/Fax

Practice location:
  • Phone: 402-475-9113
  • Fax: 402-475-8084
Mailing address:
  • Phone: 402-475-9113
  • Fax: 402-475-8084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CRISTINA LONG
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 402-475-9113