Organization
HIAWATHA LLC
Active
Other names
Lakeside Family Vision
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY J MCLAIN OD (OPTOMETRIST/OWNER)
(308) 928-2187
Entity
Organization
Contact information
Practice address
610 MAIN ST, ALMA, NE 68920-2165
(308) 928-2187
Mailing address
PO BOX 777, ALMA, NE 68920-0777
(308) 928-2187
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12737256
—
NE
Enumeration date
10/21/2021
Last updated
06/16/2022
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