Healthcare Provider Details

I. General information

NPI: 1598744732
Provider Name (Legal Business Name): MIDWEST EYE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4353 DODGE ST LOWER LEVEL
OMAHA NE
68131-2709
US

IV. Provider business mailing address

4353 DODGE ST LOWER LEVEL
OMAHA NE
68131-2709
US

V. Phone/Fax

Practice location:
  • Phone: 402-552-2020
  • Fax: 402-552-2367
Mailing address:
  • Phone: 402-552-2020
  • Fax: 402-552-2367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberASC016
License Number StateNE

VIII. Authorized Official

Name: MARK EMIG
Title or Position: OPHTHALMOLOGIST
Credential: MD
Phone: 402-552-2020