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General NPI Number Information
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NPI Number | 1205201803
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Entity Type | Organization
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Legal Business Name | ENVISION EYECARE ASSOCIATES LLC
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Dates
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Enumeration Date | 12/08/2015
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Last Update Date | 12/08/2015
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Provider Practice Location Address
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Address Line | 1171 N COTNER BLVD
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City | LINCOLN
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State | NE
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Zip | 68505-1835
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Country | US
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Telephone | 402-466-6070
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Fax |
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Provider Business Mailing Address
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Address Line | 12401 EMMAWALTER RD
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City | LINCOLN
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State | NE
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Zip | 68517-9833
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Country | US
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Telephone | 402-730-9316
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. JOSHUA WADE ENGEL
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Credential | O.D.
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Telephone | 402-730-9316
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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 | 1182
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License Number State | NE
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