Provider Demographics
NPI:1497358782
Name:HASTINGS OPTOMETRIC ASSOCIATES LLC
Entity Type:Organization
Organization Name:HASTINGS OPTOMETRIC ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:BAUMFALK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-580-3608
Mailing Address - Street 1:8201 RUSSWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2737
Mailing Address - Country:US
Mailing Address - Phone:402-580-3608
Mailing Address - Fax:
Practice Address - Street 1:3803 OSBORNE DR W
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-9139
Practice Address - Country:US
Practice Address - Phone:402-463-0052
Practice Address - Fax:402-463-0219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty