Healthcare Provider Details

I. General information

NPI: 1952349995
Provider Name (Legal Business Name): MINDY K DORSEY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MINDY K YANTZIE

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 M ST
ORD NE
68862-1428
US

IV. Provider business mailing address

PO BOX 263
ORD NE
68862-0263
US

V. Phone/Fax

Practice location:
  • Phone: 308-728-3229
  • Fax: 308-728-5908
Mailing address:
  • Phone: 308-728-3229
  • Fax: 308-728-5908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0739
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1237
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: