Provider Demographics
NPI:1124209598
Name:MK OPTICAL ENTERPRISES, INC
Entity Type:Organization
Organization Name:MK OPTICAL ENTERPRISES, INC
Other - Org Name:THE SPECTACLE PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:DINSLAGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-423-5367
Mailing Address - Street 1:5801 S 58TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6404
Mailing Address - Country:US
Mailing Address - Phone:402-423-5367
Mailing Address - Fax:402-420-5841
Practice Address - Street 1:5801 S 58TH ST
Practice Address - Street 2:STE A
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6404
Practice Address - Country:US
Practice Address - Phone:402-423-5367
Practice Address - Fax:402-420-5841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1257152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty