Provider Demographics
NPI:1235354820
Name:PROFESSIONAL EYECARE GATEWAY INC.
Entity Type:Organization
Organization Name:PROFESSIONAL EYECARE GATEWAY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:GEISERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-467-3423
Mailing Address - Street 1:6100 O ST #59
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505
Mailing Address - Country:US
Mailing Address - Phone:402-467-3423
Mailing Address - Fax:402-467-3425
Practice Address - Street 1:6100 O ST #59
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505
Practice Address - Country:US
Practice Address - Phone:402-467-3423
Practice Address - Fax:402-467-3425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty