Provider Demographics
NPI:1629095377
Name:PAUL PATSALIS, O.D. P.C.
Entity Type:Organization
Organization Name:PAUL PATSALIS, O.D. P.C.
Other - Org Name:20/20 VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATSALIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-334-3937
Mailing Address - Street 1:13471 W CENTER RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3412
Mailing Address - Country:US
Mailing Address - Phone:402-334-3937
Mailing Address - Fax:
Practice Address - Street 1:13471 W CENTER RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3412
Practice Address - Country:US
Practice Address - Phone:402-334-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1195152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty