Provider Demographics
NPI:1306191150
Name:INSIGHT VISION SERVICE PC
Entity Type:Organization
Organization Name:INSIGHT VISION SERVICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SCDORIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-431-1203
Mailing Address - Street 1:6750 WOODLAND BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:HICKMAN
Mailing Address - State:NE
Mailing Address - Zip Code:68372-9626
Mailing Address - Country:US
Mailing Address - Phone:402-657-8203
Mailing Address - Fax:
Practice Address - Street 1:6750 WOODLAND BLVD
Practice Address - Street 2:STE A
Practice Address - City:HICKMAN
Practice Address - State:NE
Practice Address - Zip Code:68372-6837
Practice Address - Country:US
Practice Address - Phone:402-792-2062
Practice Address - Fax:402-657-8203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1375152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty