Provider Demographics
NPI:1801549506
Name:VAN KOOTEN-THARMAN, ALEX MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:MICHAEL
Last Name:VAN KOOTEN-THARMAN
Suffix:
Gender:
Credentials:OD
Other - Prefix:DR
Other - First Name:ALEX
Other - Middle Name:MICHAEL
Other - Last Name:THARMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:17255 DAVENPORT ST STE 139
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-4020
Mailing Address - Country:US
Mailing Address - Phone:402-763-6466
Mailing Address - Fax:402-939-0809
Practice Address - Street 1:17255 DAVENPORT ST STE 139
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-4020
Practice Address - Country:US
Practice Address - Phone:402-763-6466
Practice Address - Fax:402-939-0809
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1568152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist