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General NPI Number Information
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NPI Number | 1710166996
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Entity Type | Organization
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Legal Business Name | MANDY O.D., P.C.
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 11/12/2021
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Provider Practice Location Address
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Address Line | 220 W 39TH ST
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City | KEARNEY
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State | NE
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Zip | 68845-2802
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Country | US
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Telephone | 308-234-9913
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Fax | 308-234-4006
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Provider Business Mailing Address
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Address Line | 5403 N AVE
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City | KEARNEY
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State | NE
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Zip | 68847-8514
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Country | US
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Telephone | 308-234-9133
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Fax | 308-234-4006
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | MANDY JANE JOHNSON
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Credential |
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Telephone | 308-234-9913
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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 | 1220
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License Number State | NE
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