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General NPI Number Information
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NPI Number | 1497358782
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Entity Type | Organization
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Legal Business Name | HASTINGS OPTOMETRIC ASSOCIATES LLC
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Dates
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Enumeration Date | 11/18/2020
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Last Update Date | 11/18/2020
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Provider Practice Location Address
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Address Line | 3803 OSBORNE DR W
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City | HASTINGS
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State | NE
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Zip | 68901-9139
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Country | US
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Telephone | 402-463-0052
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Fax | 402-463-0219
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Provider Business Mailing Address
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Address Line | 8201 RUSSWOOD CIR
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City | LINCOLN
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State | NE
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Zip | 68505-2737
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Country | US
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Telephone | 402-580-3608
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | JEREMIAH DEAN BAUMFALK
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Credential | OD
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Telephone | 402-580-3608
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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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