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General NPI Number Information
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NPI Number | 1558372821
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Entity Type | Organization
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Legal Business Name | BELLEVUE OPTICAL INC.
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1103 GALVIN RD S
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City | BELLEVUE
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State | NE
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Zip | 68005-3002
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Country | US
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Telephone | 402-291-7144
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Fax | 402-292-7122
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Provider Business Mailing Address
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Address Line | 1103 GALVIN RD S
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City | BELLEVUE
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State | NE
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Zip | 68005-3002
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Country | US
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Telephone | 402-291-7144
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Fax | 402-292-7122
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Authorized Official
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Title or Position | O.D.
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Name | DR. THOMAS W GRANGE
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Credential | O.D.
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Telephone | 402-291-7144
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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 |
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License Number State |
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