Individual
DR. DANIEL KEITH MICKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1371 29TH AVE, COLUMBUS, NE 68601
(402) 564-0545
(402) 564-0078
Mailing address
1371 29TH AVE, COLUMBUS, NE 68601-4926
(402) 564-0545
(402) 564-0078
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1069
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06952
BCBS
—
05
—
47055862700
—
NE
01
—
CH1483
RAILROAD MEDICARE GROUP #
—
Enumeration date
08/31/2006
Last updated
07/28/2008
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