Organization
ELKHORN RIDGE VISION PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW F KLEMKE O.D. (PRESIDENT)
(402) 614-4322
Entity
Organization
Contact information
Practice address
304 N. 179TH STREET, SUITE 203, OMAHA, NE 68118-3569
(402) 614-4322
(402) 614-4475
Mailing address
304 N. 179TH STREET, SUITE 203, OMAHA, NE 68118-3569
(402) 614-4322
(402) 614-4475
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1178
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37054
BCBS
NE
01
—
P00219077
RAILROAD MEDICARE DD2869
NE
Enumeration date
07/21/2006
Last updated
01/02/2020
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