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General NPI Number Information
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NPI Number | 1699062828
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Entity Type | Organization
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Legal Business Name | PREMIER EYE CARE AND CONTACT LENS SERVICES, PC
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Dates
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Enumeration Date | 07/08/2011
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 920 E 56TH ST D3
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City | KEARNEY
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State | NE
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Zip | 68847-8628
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Country | US
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Telephone | 308-455-1283
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Fax | 308-455-1285
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Provider Business Mailing Address
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Address Line | 920 E 56TH ST D3
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City | KEARNEY
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State | NE
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Zip | 68847-8628
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Country | US
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Telephone | 308-455-1283
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Fax | 308-455-1285
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. MICHAEL KELLY GILBREATH
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Credential | OD
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Telephone | 402-661-9033
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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 | 1325
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License Number State | NE
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