Healthcare Provider Details

I. General information

NPI: 1326101148
Provider Name (Legal Business Name): JON WILKINS HOUCK O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 S 73RD ST
OMAHA NE
68124-2396
US

IV. Provider business mailing address

3728 S 116TH ST
OMAHA NE
68144-4635
US

V. Phone/Fax

Practice location:
  • Phone: 402-397-1654
  • Fax: 402-397-7926
Mailing address:
  • Phone: 402-697-8966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046-009604
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1274
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: