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General NPI Number Information
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NPI Number | 1043491418
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Entity Type | Organization
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Legal Business Name | MK OPTICAL ENTERPRISES, INC.
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Dates
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Enumeration Date | 11/14/2007
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Last Update Date | 01/16/2009
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Provider Practice Location Address
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Address Line | 201 CAPITOL BEACH BLVD STE 11
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City | LINCOLN
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State | NE
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Zip | 68528-1600
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Country | US
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Telephone | 402-475-3937
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Fax | 402-475-4715
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Provider Business Mailing Address
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Address Line | 201 CAPITOL BEACH BLVD STE 11
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City | LINCOLN
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State | NE
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Zip | 68528-1600
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Country | US
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Telephone | 402-475-3937
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Fax | 402-475-4715
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MATTHEW WADE DINSLAGE
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Credential | O.D.
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Telephone | 402-475-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1257
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License Number State | NE
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