Healthcare Provider Details

I. General information

NPI: 1932576857
Provider Name (Legal Business Name): NORTHEAST EYE CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2015
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL DR
PENDER NE
68047-4507
US

IV. Provider business mailing address

101 W DECATUR ST
WEST POINT NE
68788-1407
US

V. Phone/Fax

Practice location:
  • Phone: 402-385-8972
  • Fax: 402-372-5736
Mailing address:
  • Phone: 402-372-3266
  • Fax: 402-372-5736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: BRANDON M RIDDER
Title or Position: OWNER
Credential: OD
Phone: 402-372-3266