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General NPI Number Information
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NPI Number | 1962816124
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Entity Type | Organization
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Legal Business Name | VISION CENTER EYE CARE LLC
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Dates
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Enumeration Date | 06/16/2014
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Last Update Date | 06/16/2014
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Provider Practice Location Address
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Address Line | 3010 E 23RD ST
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City | FREMONT
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State | NE
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Zip | 68025-2479
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Country | US
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Telephone | 402-727-0804
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Fax |
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Provider Business Mailing Address
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Address Line | 3010 E 23RD ST
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City | FREMONT
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State | NE
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Zip | 68025-2479
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | JEDIDIAH BURKEY
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Credential | O.D.
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Telephone | 402-727-0804
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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 | 1414
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License Number State | NE
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