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General NPI Number Information
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NPI Number | 1306521604
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Entity Type | Individual
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Provider Name | COLTEN DEAN VAHLE OD
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Gender | Male
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 07/27/2023
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Provider Practice Location Address
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Address Line | 8650 S 71ST PLZ STE D
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City | PAPILLION
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State | NE
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Zip | 68133-2133
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Country | US
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Telephone | 402-408-1016
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Fax |
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Provider Business Mailing Address
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Address Line | 57513 839 RD
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City | PILGER
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State | NE
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Zip | 68768-4011
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Country | US
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Telephone | 402-841-9057
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1623
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License Number State | NE
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