Provider Demographics
NPI:1710180740
Name:DRS. TODD & TODD
Entity Type:Organization
Organization Name:DRS. TODD & TODD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-721-8032
Mailing Address - Street 1:215 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2632
Mailing Address - Country:US
Mailing Address - Phone:402-721-8032
Mailing Address - Fax:402-721-2874
Practice Address - Street 1:215 E 22ND ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2632
Practice Address - Country:US
Practice Address - Phone:402-721-8032
Practice Address - Fax:402-721-2874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE821152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
NET40247Medicare UPIN
NE0140860001Medicare NSC
NE=========13Medicaid