Healthcare Provider Details

I. General information

NPI: 1265887160
Provider Name (Legal Business Name): EYE CARE PROFESSIONALS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 W REID AVE STE 1
NORTH PLATTE NE
69101-6582
US

IV. Provider business mailing address

810 W REID AVE STE 1
NORTH PLATTE NE
69101-6582
US

V. Phone/Fax

Practice location:
  • Phone: 308-221-2020
  • Fax: 308-221-6017
Mailing address:
  • Phone: 308-221-2020
  • Fax: 308-221-6017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1416
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. MOLLIE J GOLDEN
Title or Position: OD/OWNER
Credential: O.D.
Phone: 308-221-2020