=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154335065
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EYECARE SPECIALTIES, PC OF LINCOLN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2006
-----------------------------------------------------
Last Update Date | 02/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1445 N BELL ST
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68025-3534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-727-9220
-----------------------------------------------------
Fax | 402-727-5625
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 72
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68026-0072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-727-9050
-----------------------------------------------------
Fax | 402-727-5625
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING DEPARTMENT
-----------------------------------------------------
Name | KATIE REMINGTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 402-420-2020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 780
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 786
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------