Healthcare Provider Details
I. General information
NPI: 1992761191
Provider Name (Legal Business Name): MID-PLAINS EYECARE CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 04/25/2006
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
121 N 8TH ST
NEBRASKA CITY NE
68410-2441
US
IV. Provider business mailing address
PO BOX 691
NEBRASKA CITY NE
68410-0691
US
V. Phone/Fax
- Phone: 402-873-6696
- Fax: 402-873-5149
- Phone: 402-873-6696
- Fax: 402-873-5149
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 152W00000X |
| Taxonomy | Optometrist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
PAUL
L
SALANSKY
JR.
Title or Position: PRESIDENT
Credential: OD
Phone: 402-269-2321