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General NPI Number Information
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NPI Number | 1144530213
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Entity Type | Organization
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Legal Business Name | GOTHENBURG-COZAD VISION CLINIC,P.C.
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Dates
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Enumeration Date | 10/07/2010
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Last Update Date | 10/07/2010
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Provider Practice Location Address
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Address Line | 916 AVENUE F
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City | GOTHENBURG
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State | NE
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Zip | 69138-2060
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Country | US
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Telephone | 308-537-2601
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Fax | 308-537-7211
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Provider Business Mailing Address
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Address Line | PO BOX 449
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City | GOTHENBURG
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State | NE
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Zip | 69138-0449
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Country | US
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Telephone | 308-537-2601
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Fax | 308-537-7211
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. LARRY D. GARRETT
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Credential | O.D.
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Telephone | 308-537-2601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 743
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License Number State | NE
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