Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 002462 | IA |
Y | 152W00000X | Optometrist | 1342 | NE |
NPI | 1003046087 |
---|---|
Provider Name | Krystal Ann Wells |
First Address | Omaha, NE 68131-2709 |
Second Address | Omaha, NE 68131-2709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2009 |
Last Update Date | 09/09/2021 |