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General NPI Number Information
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NPI Number | 1649697491
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Entity Type | Organization
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Legal Business Name | NORTHEAST EYECARE PC
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Dates
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Enumeration Date | 03/18/2014
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Last Update Date | 08/17/2015
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Provider Practice Location Address
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Address Line | 101 W DECATUR ST
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City | WEST POINT
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State | NE
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Zip | 68788-1407
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Country | US
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Telephone | 402-372-3266
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Fax | 402-372-5736
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Provider Business Mailing Address
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Address Line | 101 W DECATUR ST
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City | WEST POINT
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State | NE
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Zip | 68788-1407
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Country | US
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Telephone | 402-372-3266
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Fax | 402-372-5736
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRANDON RIDDER
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Credential | OD
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Telephone | 402-372-3266
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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 | 1396
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License Number State | NE
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