Provider Demographics
NPI:1861626806
Name:RETINA CENTER OF NEBRASKA, P.C.
Entity Type:Organization
Organization Name:RETINA CENTER OF NEBRASKA, P.C.
Other - Org Name:RETINA CENTER OF NEBRASKA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-461-4611
Mailing Address - Street 1:2115 N KANSAS AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-2615
Mailing Address - Country:US
Mailing Address - Phone:402-461-4611
Mailing Address - Fax:402-461-4616
Practice Address - Street 1:2115 N KANSAS AVE STE 104
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-2615
Practice Address - Country:US
Practice Address - Phone:402-461-4611
Practice Address - Fax:402-461-4616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15430207W00000X, 207WX0107X
207WX0107X
NE28285207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026498300Medicaid