Provider Demographics
NPI:1396773529
Name:PAPILLION OPTICAL, INC.
Entity type:Organization
Organization Name:PAPILLION OPTICAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:M.D./PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MANAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-934-8040
Mailing Address - Street 1:535 FORTUNE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046
Mailing Address - Country:US
Mailing Address - Phone:402-934-8040
Mailing Address - Fax:402-934-9506
Practice Address - Street 1:535 FORTUNE DRIVE
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046
Practice Address - Country:US
Practice Address - Phone:402-934-8040
Practice Address - Fax:402-934-9506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier