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General NPI Number Information
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NPI Number | 1588851117
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Entity Type | Organization
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Legal Business Name | GOEKEN EYE CARE, LLC
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 09/27/2007
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Provider Practice Location Address
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Address Line | 7474 TOWN CENTER PKWY DR SUITE 107
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City | PAPILLION
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State | NE
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Zip | 68046-4805
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Country | US
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Telephone | 402-592-3266
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Fax | 402-592-3249
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Provider Business Mailing Address
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Address Line | 7474 TOWN CENTER PKWY DR SUITE 107
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City | PAPILLION
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State | NE
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Zip | 68046-4805
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Country | US
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Telephone | 402-592-3266
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Fax | 402-592-3249
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Authorized Official
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Title or Position | SOLE OWNER
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Name | DR. JESSICA ELAINE GOEKEN
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Credential | OD
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Telephone | 402-592-3266
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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 | 1287
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License Number State | NE
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