Provider Demographics
NPI:1659859734
Name:VISION SPECIALISTS OF PAPILLION LLC
Entity Type:Organization
Organization Name:VISION SPECIALISTS OF PAPILLION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-322-3097
Mailing Address - Street 1:2514 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-3509
Mailing Address - Country:US
Mailing Address - Phone:712-322-3097
Mailing Address - Fax:712-322-4130
Practice Address - Street 1:120 OLSON DRIVE SUITE 107
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046
Practice Address - Country:US
Practice Address - Phone:712-322-3097
Practice Address - Fax:712-322-4130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty