Healthcare Provider Details

I. General information

NPI: 1639120173
Provider Name (Legal Business Name): SENIOR MEDICAL SPECIALTIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9239 W CENTER RD SUITE 103
OMAHA NE
68124-1900
US

IV. Provider business mailing address

PO BOX 30152
OMAHA NE
68103-1252
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: MARK A COOLEY
Title or Position: PRESIDENT
Credential:
Phone: 888-840-3032