Healthcare Provider Details

I. General information

NPI: 1598714008
Provider Name (Legal Business Name): LYNDON GRAVES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9239 W CENTER RD SUITE 103
OMAHA NE
68124-1933
US

IV. Provider business mailing address

9239 W CENTER RD SUITE 103
OMAHA NE
68124-1933
US

V. Phone/Fax

Practice location:
  • Phone: 402-898-3232
  • Fax: 402-898-3234
Mailing address:
  • Phone: 402-898-3232
  • Fax: 402-898-3234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number998
License Number StateNE

VIII. Authorized Official

Name: LYNDON JAY GRAVES
Title or Position: OWNER/OPTOMETRIST
Credential: O.D.
Phone: 402-898-3232