Provider Demographics
NPI:1891771051
Name:GRAND ISLAND OPTICAL PC
Entity Type:Organization
Organization Name:GRAND ISLAND OPTICAL PC
Other - Org Name:EYECARE PROFESSIONALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY / OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:LANGFORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:308-384-0220
Mailing Address - Street 1:PO BOX 5076
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-5076
Mailing Address - Country:US
Mailing Address - Phone:308-384-0220
Mailing Address - Fax:308-382-1650
Practice Address - Street 1:420 N DIERS AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4979
Practice Address - Country:US
Practice Address - Phone:308-384-0220
Practice Address - Fax:308-382-1650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Not Answered332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
07783OtherBLUE CROSS BLUE SHIELD
CS1323OtherRAILROAD MEDICARE
0290380001OtherMEDICARE DMERC
0290380001OtherMEDICARE DMERC