Organization
WAKAN PATH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LYNDON GRAVES DO (PRESIDENT)
(402) 210-6129
Entity
Organization
Contact information
Practice address
5018 AMES AVE, OMAHA, NE 68104-2323
(402) 970-9301
Mailing address
4913 CALIFORNIA ST, OMAHA, NE 68132-2417
(402) 210-6129
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
198
NE
Other
Enumeration date
08/28/2018
Last updated
11/13/2018
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