Provider Demographics
NPI:1871648386
Name:RIENKS, DOUGLAS C (OD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:C
Last Name:RIENKS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 SUPERIOR STREET
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521
Mailing Address - Country:US
Mailing Address - Phone:402-435-1166
Mailing Address - Fax:402-435-1194
Practice Address - Street 1:2550 SUPERIOR STREET
Practice Address - Street 2:SUITE 150
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521
Practice Address - Country:US
Practice Address - Phone:402-435-1166
Practice Address - Fax:402-435-1194
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1014152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470839840OtherVISION SERVICE PLAN
NE470839840OtherUNITED HEALTH CARE
NE36355OtherBLUE CROSS BLUE SHIELD
NE47083984000Medicaid
NE470839840OtherMIDLANDS CHOICE
NE36355OtherBLUE CROSS BLUE SHIELD
NE47083984000Medicaid
NE4112760001Medicare NSC