Provider Demographics
NPI:1700874641
Name:FLEECS, BEVERLY
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:
Last Name:FLEECS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7121 A ST
Mailing Address - Street 2:SUITE #202
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4202
Mailing Address - Country:US
Mailing Address - Phone:402-486-3937
Mailing Address - Fax:
Practice Address - Street 1:7121 A ST
Practice Address - Street 2:SUITE #202
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4202
Practice Address - Country:US
Practice Address - Phone:402-486-3937
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47082706800Medicaid