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General NPI Number Information
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NPI Number | 1548703754
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Entity Type | Organization
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Legal Business Name | DISCOUNT EYEWEAR
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Dates
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Enumeration Date | 11/21/2016
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Last Update Date | 11/21/2016
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Provider Practice Location Address
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Address Line | 3008 N 24TH ST
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City | OMAHA
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State | NE
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Zip | 68110-2026
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Country | US
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Telephone | 402-714-3149
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Fax |
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Provider Business Mailing Address
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Address Line | 3008 N 24TH ST
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City | OMAHA
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State | NE
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Zip | 68110-2026
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Country | US
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Telephone | 402-714-3149
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Fax |
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Authorized Official
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Title or Position | OWNWE
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Name | MR. WILLIAM EARL HAYNES
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Credential | CERTIFIED OPTICIAN
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Telephone | 402-714-3149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 156FX1800X
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License Number State | NE
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