Provider Demographics
NPI:1457612756
Name:EYENET, P.C.
Entity Type:Organization
Organization Name:EYENET, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:JURADO
Authorized Official - Last Name:ASTUTO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-707-0887
Mailing Address - Street 1:7421 S 95TH ST
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-8234
Mailing Address - Country:US
Mailing Address - Phone:402-707-0887
Mailing Address - Fax:402-997-4076
Practice Address - Street 1:12850 L ST
Practice Address - Street 2:STORE 5361
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2078
Practice Address - Country:US
Practice Address - Phone:402-697-1852
Practice Address - Fax:402-697-4834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1270152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025829000Medicaid