1174847560 NPI number — NEW COLUMBIAN OPTICAL COMPANY

Table of content: (NPI 1174847560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174847560 NPI number — NEW COLUMBIAN OPTICAL COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW COLUMBIAN OPTICAL COMPANY
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:
6
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:
1174847560
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 N 72ND ST
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:
68114-3605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-551-9541
Provider Business Mailing Address Fax Number:
402-551-9606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5720 BURNET RD
Provider Second Line Business Practice Location Address:
B
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78756-1113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-467-6968
Provider Business Practice Location Address Fax Number:
512-467-2285
Provider Enumeration Date:
03/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SANDMAN
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
516-944-7161

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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