Provider Demographics
NPI:1316586464
Name:ELKHORN RIDGE VISION PC
Entity Type:Organization
Organization Name:ELKHORN RIDGE VISION PC
Other - Org Name:VIEWPOINTE VISION-GILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CRIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-614-4322
Mailing Address - Street 1:PO BOX 714
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NE
Mailing Address - Zip Code:68769-0714
Mailing Address - Country:US
Mailing Address - Phone:402-335-7963
Mailing Address - Fax:
Practice Address - Street 1:304 N 179TH ST STE 203
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-3569
Practice Address - Country:US
Practice Address - Phone:402-614-4322
Practice Address - Fax:402-614-4475
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELKHORN RIDGE VISION PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-06
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty