Healthcare Provider Details

I. General information

NPI: 1700874641
Provider Name (Legal Business Name): MS. BEVERLY FLEECS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7121 A ST SUITE #202
LINCOLN NE
68510-4202
US

IV. Provider business mailing address

7121 A ST SUITE #202
LINCOLN NE
68510-4202
US

V. Phone/Fax

Practice location:
  • Phone: 402-486-3937
  • Fax:
Mailing address:
  • Phone: 402-486-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: