Provider Demographics
NPI:1629585716
Name:MRT OPTOMETRY, P.C.
Entity Type:Organization
Organization Name:MRT OPTOMETRY, P.C.
Other - Org Name:IDEAL EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-256-8898
Mailing Address - Street 1:6914 N 102ND CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-3056
Mailing Address - Country:US
Mailing Address - Phone:402-215-2020
Mailing Address - Fax:
Practice Address - Street 1:6914 N 102ND CIR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-3056
Practice Address - Country:US
Practice Address - Phone:402-215-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1357152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty