Provider Demographics
NPI:1154094316
Name:RADIANT FAMILY EYECARE LLC
Entity Type:Organization
Organization Name:RADIANT FAMILY EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:GINNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:AHRENS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-380-3558
Mailing Address - Street 1:1425 N 181ST AVE
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-3883
Mailing Address - Country:US
Mailing Address - Phone:402-380-3558
Mailing Address - Fax:402-884-2885
Practice Address - Street 1:20330 VETERANS DR STE 4
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-6929
Practice Address - Country:US
Practice Address - Phone:402-885-7695
Practice Address - Fax:402-884-2885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty