Provider Demographics
NPI:1518960871
Name:VONDRAK, HARRY NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:NICHOLAS
Last Name:VONDRAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901
Mailing Address - Country:US
Mailing Address - Phone:402-462-9191
Mailing Address - Fax:402-462-9192
Practice Address - Street 1:1414 W 12TH ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901
Practice Address - Country:US
Practice Address - Phone:402-462-9191
Practice Address - Fax:402-462-9192
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12212207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS10017210AMedicaid
NE04241OtherBCBS
NE47055104100Medicaid
NE10025428000Medicaid
KS274964Medicaid
NE280574Medicare ID - Type Unspecified
NE04241OtherBCBS
KS10017210AMedicaid
KS274964Medicaid