Provider Demographics
NPI:1952349995
Name:DORSEY, MINDY K (OD)
Entity type:Individual
Prefix:DR
First Name:MINDY
Middle Name:K
Last Name:DORSEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:K
Other - Last Name:YANTZIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:ORD
Mailing Address - State:NE
Mailing Address - Zip Code:68862-0263
Mailing Address - Country:US
Mailing Address - Phone:308-728-3229
Mailing Address - Fax:308-728-5908
Practice Address - Street 1:1511 M ST
Practice Address - Street 2:
Practice Address - City:ORD
Practice Address - State:NE
Practice Address - Zip Code:68862-1428
Practice Address - Country:US
Practice Address - Phone:308-728-3229
Practice Address - Fax:308-728-5908
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0739152W00000X
NE1237152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30353026Medicaid
NH999995603OtherVISION SERVICE PLAN
NH150458OtherHEALTHSOURCE
NHNH0739OtherEYE MED
NH09Y004092NH01OtherANTHEM
NE10025387200Medicaid
NH30353026Medicaid