Healthcare Provider Details

I. General information

NPI: 1265433395
Provider Name (Legal Business Name): DEAN L. LAURITZEN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 08/05/2014
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 P.O. BOX 367
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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: