Healthcare Provider Details

I. General information

NPI: 1629098538
Provider Name (Legal Business Name): DAVIDS EYECARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17660 WRIGHT ST. SUITE 18
OMAHA NE
68130
US

IV. Provider business mailing address

17660 WRIGHT ST. SUITE 18
OMAHA NE
68130
US

V. Phone/Fax

Practice location:
  • Phone: 402-991-0160
  • Fax: 402-991-0453
Mailing address:
  • Phone: 402-991-0160
  • Fax: 402-991-0453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberNE847
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID W KOVAR
Title or Position: PRESIDENT, DAVIDS EYECARE INC
Credential:
Phone: 402-450-9111