Provider Demographics
NPI:1548703754
Name:DISCOUNT EYEWEAR
Entity type:Organization
Organization Name:DISCOUNT EYEWEAR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNWE
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED OPTICIAN
Authorized Official - Phone:402-714-3149
Mailing Address - Street 1:3008 N 24TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68110-2026
Mailing Address - Country:US
Mailing Address - Phone:402-714-3149
Mailing Address - Fax:
Practice Address - Street 1:3008 N 24TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68110-2026
Practice Address - Country:US
Practice Address - Phone:402-714-3149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE156FX1800X332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1861708034Medicaid