Professional Provider Company, LLC

NPI #1881920288 in Omaha, Nebraska

Provider Information

NPI Number: 1881920288
Entity Type: Organization
Organization Name: Professional Provider Company, LLC
Primary Specialty: Optometrist
Enumeration Date: Oct 20, 2009
Last Updated: Mar 17, 2018

Practice Location

Address: 10826 OLD MILL RD STE 101
City: Omaha
State: Nebraska
ZIP Code: 68154-2660
Phone: (888) 840-3032

Authorized Official

Name: LYNDON J GRAVES, OD
Title: OWNER
Phone: (888) 840-3032

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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