Provider Demographics
NPI:1891968871
Name:WB ENTERPRISES
Entity Type:Organization
Organization Name:WB ENTERPRISES
Other - Org Name:PHYSICIANS OPTICAL SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:ATHEY
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:308-865-2757
Mailing Address - Street 1:3808 28TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-1290
Mailing Address - Country:US
Mailing Address - Phone:308-865-2757
Mailing Address - Fax:308-865-2758
Practice Address - Street 1:3808 28TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-1290
Practice Address - Country:US
Practice Address - Phone:308-865-2757
Practice Address - Fax:308-865-2758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE26981ABOC156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025321800Medicaid
NE10025321800Medicaid