Provider Demographics
NPI:1154094118
Name:EOL STUDIO 1
Entity Type:Organization
Organization Name:EOL STUDIO 1
Other - Org Name:EYES ON LINCOLN VISION STUDIO 1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-475-9113
Mailing Address - Street 1:4200 LUCILE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-6032
Mailing Address - Country:US
Mailing Address - Phone:402-475-9113
Mailing Address - Fax:402-475-8084
Practice Address - Street 1:4200 LUCILE DR STE 300
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-6032
Practice Address - Country:US
Practice Address - Phone:402-475-9113
Practice Address - Fax:402-475-8084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-27
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty