Organization
MK OPTICAL ENTERPRISES, INC.
Active
Other names
The Spectacle Place
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW WADE DINSLAGE O.D. (PRESIDENT)
(402) 475-3937
Entity
Organization
Contact information
Practice address
201 CAPITOL BEACH BLVD, STE 11, LINCOLN, NE 68528-1600
(402) 475-3937
(402) 475-4715
Mailing address
201 CAPITOL BEACH BLVD, STE 11, LINCOLN, NE 68528-1600
(402) 475-3937
(402) 475-4715
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1257
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025560100
—
NE
05
—
10025562700
—
NE
01
—
37187
BLUE CROSS/ BLUE SHIELD OF NEBRASKA
NE
Enumeration date
11/14/2007
Last updated
01/16/2009
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