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General NPI Number Information
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NPI Number | 1396408720
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Entity Type | Organization
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Legal Business Name | HIAWATHA LLC
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Dates
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Enumeration Date | 10/21/2021
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Last Update Date | 06/16/2022
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Provider Practice Location Address
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Address Line | 610 MAIN ST
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City | ALMA
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State | NE
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Zip | 68920-2165
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Country | US
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Telephone | 308-928-2187
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 777
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City | ALMA
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State | NE
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Zip | 68920-0777
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Country | US
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Telephone | 308-928-2187
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | KELLY J MCLAIN
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Credential | OD
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Telephone | 308-928-2187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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