Provider Demographics
NPI:1700955929
Name:OPTICAL OPTIONS
Entity Type:Organization
Organization Name:OPTICAL OPTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIETZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-462-9009
Mailing Address - Street 1:715 N KANSAS AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901
Mailing Address - Country:US
Mailing Address - Phone:402-462-9009
Mailing Address - Fax:402-462-8090
Practice Address - Street 1:715 N KANSAS AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901
Practice Address - Country:US
Practice Address - Phone:402-462-9009
Practice Address - Fax:402-462-8090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
305S00000X
NE332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE4318660001Medicare ID - Type Unspecified