| Lake Avenue Eyecare Llc | |
|
829 Lake Ave, Gothenburg, NE 69138-1943 | |
| (308) 537-3390 | |
| (308) 537-3391 |
| Full Name | Lake Avenue Eyecare Llc |
|---|---|
| Type | Facility |
| Speciality | Eyewear Supplier |
| Location | 829 Lake Ave, Gothenburg, Nebraska |
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396932430 | NPI | - | NPPES |
| 240481 | Other | MIDLANDS CHOICE | |
| 06754 | Other | BLUE CROSS BLUE SHIELDPIN | |
| 10024987700 | Medicaid | NE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | 1166 (Nebraska) | Secondary |
| 332H00000X | Eyewear Supplier | 1166 (Nebraska) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Avenue Eyecare Llc 829 Lake Ave, Gothenburg, NE 69138-1943 Ph: (308) 537-3390 | Lake Avenue Eyecare Llc 829 Lake Ave, Gothenburg, NE 69138-1943 Ph: (308) 537-3390 |
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