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General NPI Number Information
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NPI Number | 1699277855
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Entity Type | Organization
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Legal Business Name | WAYNE EYE CARE PC
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Dates
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Enumeration Date | 03/05/2018
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Last Update Date | 01/27/2020
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Provider Practice Location Address
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Address Line | 313 MAIN ST
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City | WAYNE
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State | NE
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Zip | 68787-1925
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Country | US
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Telephone | 402-375-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 105 GAUL DR
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City | SERGEANT BLUFF
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State | IA
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Zip | 51054-8963
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Country | US
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Telephone | 712-943-9400
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. RACHEL LOUISE VANDEKOP
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Credential |
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Telephone | 712-943-9400
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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 | 1477
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 087587
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1476
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License Number State | NE
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2439
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License Number State | IA
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