Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 1123 | NE |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 1123 | NE |
N | 152WS0006X | Sports Vision | 1123 | NE |
NPI | 1033161245 |
---|---|
Provider Name | Dr. Steven Edward Wise |
First Address | Lincoln, NE 68512-9431 |
Second Address | Lincoln, NE 68512-3692 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U73421 | (02) | NE |