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General NPI Number Information
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NPI Number | 1154094118
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Entity Type | Organization
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Legal Business Name | EOL STUDIO 1
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Dates
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Enumeration Date | 07/27/2021
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Last Update Date | 07/28/2021
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Provider Practice Location Address
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Address Line | 4200 LUCILE DR STE 300
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City | LINCOLN
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State | NE
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Zip | 68506-6032
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Country | US
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Telephone | 402-475-9113
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Fax | 402-475-8084
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Provider Business Mailing Address
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Address Line | 4200 LUCILE DR STE 300
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City | LINCOLN
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State | NE
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Zip | 68506-6032
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Country | US
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Telephone | 402-475-9113
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Fax | 402-475-8084
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | CRISTINA LONG
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Credential |
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Telephone | 402-475-9113
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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 |
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License Number State |
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