Organization
PROFESSIONAL PROVIDER COMPANY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNDON J GRAVES OD (OWNER)
(888) 840-3032
Entity
Organization
Contact information
Practice address
10826 OLD MILL RD STE 101, OMAHA, NE 68154-2660
(888) 840-3032
(888) 840-8937
Mailing address
10826 OLD MILL RD STE 101, OMAHA, NE 68154-2660
(888) 840-3032
(888) 840-8937
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881920288
—
OR
Enumeration date
10/20/2009
Last updated
03/17/2018
About Stedi
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