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General NPI Number Information
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NPI Number | 1972342657
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Entity Type | Organization
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Legal Business Name | LOCAL EYES CUSTOM OPTOMETRY
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Dates
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Enumeration Date | 05/22/2024
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 5701 BOBOLI LN STE 101
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City | LINCOLN
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State | NE
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Zip | 68516-3407
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Country | US
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Telephone | 402-423-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 2710 WOODSCREST AVE
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City | LINCOLN
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State | NE
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Zip | 68502-4059
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Country | US
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Telephone | 402-730-4891
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | KIMBERLY J TUCKER
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Credential | OD
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Telephone | 402-423-3937
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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 |
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License Number State |
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