Healthcare Provider Details

I. General information

NPI: 1790780369
Provider Name (Legal Business Name): JOHN EUGENE BATEMAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

2380 8TH AVE STE 4
PLATTSMOUTH NE
68048-2367
US

IV. Provider business mailing address

2380 8TH AVE STE 4
PLATTSMOUTH NE
68048-2367
US

V. Phone/Fax

Practice location:
  • Phone: 402-296-2200
  • Fax: 402-296-6055
Mailing address:
  • Phone: 402-296-2200
  • Fax: 402-296-6055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number911
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: