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Individual

DEREK FRANCIS BLUMENSTOCK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1501 PINE LAKE RD STE 1, LINCOLN, NE 68512-3692
(402) 421-7773
Mailing address
6716 S 34TH ST, LINCOLN, NE 68516-5436
(832) 404-0099

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1499
NE
390200000X
Student in an Organized Health Care Education/Training Program

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1499
STATE ID #
NE
Enumeration date
04/02/2019
Last updated
06/04/2019
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