Healthcare Provider Details

I. General information

NPI: 1174249833
Provider Name (Legal Business Name): EYE PHYSICIANS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2022
Last Update Date: 10/14/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W BENJAMIN AVE
NORFOLK NE
68701-3119
US

IV. Provider business mailing address

PO BOX 1275
COLUMBUS NE
68602-1275
US

V. Phone/Fax

Practice location:
  • Phone: 402-371-3158
  • Fax: 402-371-3466
Mailing address:
  • Phone: 402-563-3686
  • Fax: 402-563-3084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: RUTH A DIEDRICHSEN
Title or Position: BILLING / HR
Credential:
Phone: 402-563-3686