Provider Demographics
NPI:1538365481
Name:PRECISION VISION PC
Entity type:Organization
Organization Name:PRECISION VISION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BONNES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:308-384-9505
Mailing Address - Street 1:724 N DIERS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4954
Mailing Address - Country:US
Mailing Address - Phone:308-384-9505
Mailing Address - Fax:308-384-4939
Practice Address - Street 1:724 N DIERS AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4954
Practice Address - Country:US
Practice Address - Phone:308-384-9505
Practice Address - Fax:308-384-4939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE1041152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025072000Medicaid
NEDB5172Medicare PIN
NE099523Medicare PIN
NE5298720001Medicare NSC