Healthcare Provider Details

I. General information

NPI: 1417952995
Provider Name (Legal Business Name): EYE SURGICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 S 70TH ST
LINCOLN NE
68506
US

IV. Provider business mailing address

PO BOX 6068
LINCOLN NE
68506-0068
US

V. Phone/Fax

Practice location:
  • Phone: 402-484-9000
  • Fax: 402-483-4223
Mailing address:
  • Phone: 402-484-9000
  • Fax: 402-483-4223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number22765
License Number StateNE

VIII. Authorized Official

Name: GREGORY E SUTTON
Title or Position: GROUP PRESIDENT
Credential: MD
Phone: 402-484-9000