Provider Demographics
NPI:1710178892
Name:OPTOMETRIC CENTER OF COLUMBUS, P.C.
Entity Type:Organization
Organization Name:OPTOMETRIC CENTER OF COLUMBUS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:R
Authorized Official - Last Name:TROFHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-564-2020
Mailing Address - Street 1:3702 23RD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-3023
Mailing Address - Country:US
Mailing Address - Phone:402-564-2020
Mailing Address - Fax:402-563-2020
Practice Address - Street 1:3702 23RD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-3023
Practice Address - Country:US
Practice Address - Phone:402-564-2020
Practice Address - Fax:402-563-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE866152W00000X
NE945152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
NE0248010001Medicare NSC
NE093163Medicare PIN