Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FC0801X | Contact Lens Fitter |
NPI | 1700874641 |
---|---|
Provider Name | Ms. Beverly Fleecs |
First Address | Lincoln, NE 68510-4202 |
Second Address | Lincoln, NE 68510-4202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47082706800 | (05) | NE |