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General NPI Number Information
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NPI Number | 1770852196
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PROVIDER ENTERPRISE LLC
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Dates
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Enumeration Date | 12/14/2011
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 10826 OLD MILL RD STE 101
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City | OMAHA
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State | NE
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Zip | 68154-2660
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Country | US
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Telephone | 402-898-3232
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Fax | 402-898-3234
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Provider Business Mailing Address
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Address Line | 10826 OLD MILL RD STE 101
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City | OMAHA
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State | NE
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Zip | 68154-2660
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Country | US
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Telephone | 888-840-3032
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Fax | 888-270-3811
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Authorized Official
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Title or Position | CCO
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Name | JOHN ROSENBAUM
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Credential |
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Telephone | 913-647-7926
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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 | 01891
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License Number State | IA
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