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General NPI Number Information
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NPI Number | 1952630055
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Entity Type | Organization
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Legal Business Name | PROFFITT EYE ASSOCIATES LLC
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Dates
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Enumeration Date | 12/18/2009
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Last Update Date | 05/12/2010
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Provider Practice Location Address
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Address Line | 711 N CUSTER AVE
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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 | 308-382-1781
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Fax | 308-382-1474
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Provider Business Mailing Address
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Address Line | 711 N CUSTER AVE
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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 | 308-382-1781
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Fax | 308-382-1474
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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 | 308-382-1781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State | NE
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