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General NPI Number Information
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NPI Number | 1871542241
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Entity Type | Organization
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Legal Business Name | WAKAN VISION INC
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 03/17/2018
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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 |
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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 | 402-898-3232
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Fax | 402-898-3234
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK A COOLEY
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Credential |
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Telephone | 402-898-3232
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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 | 2277
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License Number State | CO
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