Healthcare Provider Details

I. General information

NPI: 1427132901
Provider Name (Legal Business Name): FAMILY VISION CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W DECATUR ST
WEST POINT NE
68788-1407
US

IV. Provider business mailing address

101 W DECATUR ST
WEST POINT NE
68788-1407
US

V. Phone/Fax

Practice location:
  • Phone: 402-372-3266
  • 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 Number767
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number767
License Number StateNE

VIII. Authorized Official

Name: DR. DEAN L LAURITZEN
Title or Position: OWNER
Credential: O.D.
Phone: 402-372-3266