Healthcare Provider Details

I. General information

NPI: 1386839025
Provider Name (Legal Business Name): SPEC SHOPPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7121 A ST SUITE #202
LINCOLN NE
68510-4289
US

IV. Provider business mailing address

7121 A ST SUITE #202
LINCOLN NE
68510-4289
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 Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MRS. BEVERLY ISRAELSON
Title or Position: OPTICIAN/OWNER
Credential:
Phone: 402-486-3937