Professional Provider Enterprise LLC

NPI #1770852196 in Omaha, Nebraska

Provider Information

NPI Number: 1770852196
Entity Type: Organization
Organization Name: Professional Provider Enterprise LLC
Primary Specialty: Optometrist
Enumeration Date: Dec 14, 2011
Last Updated: Aug 22, 2025

Practice Location

Address: 10826 OLD MILL RD STE 101
City: Omaha
State: Nebraska
ZIP Code: 68154-2660
Phone: (402) 898-3232

Authorized Official

Name: JOHN ROSENBAUM
Title: CCO
Phone: (913) 647-7926

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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