Healthcare Provider Details

I. General information

NPI: 1174847560
Provider Name (Legal Business Name): NEW COLUMBIAN OPTICAL COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5720 BURNET RD B
AUSTIN TX
78756-1113
US

IV. Provider business mailing address

325 N 72ND ST
OMAHA NE
68114-3605
US

V. Phone/Fax

Practice location:
  • Phone: 512-467-6968
  • Fax: 512-467-2285
Mailing address:
  • Phone: 402-551-9541
  • Fax: 402-551-9606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. ALAN SANDMAN
Title or Position: COO
Credential: RETAIL DIRECTOR
Phone: 516-944-7161