Provider Demographics
NPI:1700881968
Name:HOLDREGE FAMILY VISION CLINIC PC
Entity Type:Organization
Organization Name:HOLDREGE FAMILY VISION CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:QUINCY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:308-995-8697
Mailing Address - Street 1:503 MCMILLAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-2052
Mailing Address - Country:US
Mailing Address - Phone:308-995-8697
Mailing Address - Fax:308-995-6931
Practice Address - Street 1:503 MCMILLAN ST
Practice Address - Street 2:
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-2052
Practice Address - Country:US
Practice Address - Phone:308-995-8697
Practice Address - Fax:308-995-6931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE831 AND 904152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE070602OtherBCBS GROUP
NE=========OtherTRICARE
NE070602OtherBCBS GROUP
NE=========13Medicaid
NE=========OtherSECURE HORIZONS
NE=========OtherUNICARE
NE070602OtherBCBS GROUP
NE=========OtherSECURE HORIZONS