| NPI | 1619121027 |
|---|---|
| Doing Business As | PROFESSIONAL EYECARE SHADOW LAKE |
| Entity Type | Organization |
| Authorized Contact | MICHAEL MARTIN YOUNG Owner 402-393-5876 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NE NE1064) |
| Enumeration Date | 2008-11-12 |
| Last Update Date | 2009-07-13 |