1073906491 NPI number — ANH TAYLOR OPTOMETRY SERVICES, LLC

Table of content: (NPI 1073906491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073906491 NPI number — ANH TAYLOR OPTOMETRY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANH TAYLOR OPTOMETRY SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073906491
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8936 N 56TH AVENUE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68152-1781
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-316-8077
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1606 S 72ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68124-1600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-393-9576
Provider Business Practice Location Address Fax Number:
402-393-9578
Provider Enumeration Date:
03/10/2015

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
ANH
Authorized Official Middle Name:
THI-TUYET
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
402-316-8077

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  NE 1189 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com