Provider Demographics
NPI:1922343680
Name:ADVANCED EYE CARE, LLC
Entity Type:Organization
Organization Name:ADVANCED EYE CARE, LLC
Other - Org Name:ADVANCED EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-462-9191
Mailing Address - Street 1:1414 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-3742
Mailing Address - Country:US
Mailing Address - Phone:402-462-9191
Mailing Address - Fax:402-462-9192
Practice Address - Street 1:1414 W 12TH ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3742
Practice Address - Country:US
Practice Address - Phone:402-462-9191
Practice Address - Fax:402-462-9192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty