Provider Demographics
NPI:1184156069
Name:MIXAN EYECARE, INC.
Entity type:Organization
Organization Name:MIXAN EYECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MIXAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:641-373-1951
Mailing Address - Street 1:805 W CENTENNIAL RD
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-7017
Mailing Address - Country:US
Mailing Address - Phone:531-233-5680
Mailing Address - Fax:531-215-0937
Practice Address - Street 1:12424 W DODGE RD STE 104
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2322
Practice Address - Country:US
Practice Address - Phone:531-233-5680
Practice Address - Fax:531-215-0937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1455152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty