Individual
DEREK LUKE MADDOX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3540 PRAIRIEVIEW ST, GRAND ISLAND, NE 68803
(308) 384-6922
(308) 384-7824
Mailing address
3540 PRAIRIEVIEW ST, GRAND ISLAND, NE 68803
(308) 384-6922
(308) 384-7824
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1516
NE
Other
Enumeration date
08/03/2020
Last updated
12/14/2023
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