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General NPI Number Information
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NPI Number | 1790788677
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Entity Type | Organization
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Legal Business Name | PHYSICIANS EYEWEAR, L.L.C.
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 04/21/2011
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Provider Practice Location Address
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Address Line | 711 N CUSTER AVE STE 2
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City | GRAND ISLAND
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State | NE
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Zip | 68803-4311
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Country | US
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Telephone | 308-382-7223
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Fax | 308-382-6299
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Provider Business Mailing Address
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Address Line | 711 N CUSTER AVE STE 2
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City | GRAND ISLAND
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State | NE
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Zip | 68803-4311
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Country | US
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Telephone | 308-382-7223
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Fax | 308-382-6299
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT S. PROFFITT
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Credential | M.D.
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Telephone | 308-382-7223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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