Provider Demographics
NPI:1265433395
Name:LAURITZEN, DEAN L (OD)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:L
Last Name:LAURITZEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W DECATUR ST
Mailing Address - Street 2:P.O. BOX 367
Mailing Address - City:WEST POINT
Mailing Address - State:NE
Mailing Address - Zip Code:68788-1407
Mailing Address - Country:US
Mailing Address - Phone:402-372-3266
Mailing Address - Fax:402-372-5736
Practice Address - Street 1:101 W DECATUR ST
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:NE
Practice Address - Zip Code:68788-1407
Practice Address - Country:US
Practice Address - Phone:402-372-3266
Practice Address - Fax:402-372-5736
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE767152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47062704912Medicaid
NE47062704900Medicaid
NE6717OtherBLUE CROSS OF NE
NE465019378OtherBLUE CROSS BLUE SHIELD OF NE
NE465019378Medicaid
NE47062704906Medicaid
NE465019378OtherBLUE CROSS BLUE SHIELD OF NE
NE098423Medicare ID - Type UnspecifiedOAKLAND OFFICE
NE465019378Medicaid
NE0257160001Medicare NSC
NE47062704900Medicaid
NE47062704912Medicaid
NE0257160006Medicare NSC