NPIMap

Organization Active NPI

Wakan Path, LLC

  • Optometrist
  • Omaha, NE
National Provider Identifier
1730660580
Registry record updated Nov 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
198 Issued in NE
Legal business name
WAKAN PATH, LLC
Practice address
5018 Ames Ave
Omaha, NE 68104-2323
Phone
(402) 970-9301
NPI assigned
Aug 28, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Lyndon Graves, DO
Title
President
Phone
(402) 210-6129

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 198 NE Primary

Addresses

Primary practice location

5018 Ames Ave
Omaha, NE 68104-2323

Mailing address

4913 California St
Omaha, NE 68132-2417
Phone (402) 210-6129

Other practice location 1

4913 California St
Omaha, NE 68132-2417
Phone (402) 210-6129

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1535414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542067200000",
    "number": "1730660580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4913 CALIFORNIA ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681322417",
            "telephone_number": "402-210-6129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5018 AMES AVE",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681042323",
            "telephone_number": "402-970-9301"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4913 California St",
            "address_purpose": "LOCATION",
            "city": "Omaha",
            "state": "NE",
            "postal_code": "681322417",
            "country_code": "US",
            "telephone_number": "402-210-6129",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WAKAN PATH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-28",
        "last_updated": "2018-11-13",
        "status": "A",
        "authorized_official_last_name": "GRAVES",
        "authorized_official_first_name": "LYNDON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "402-210-6129",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NE",
            "license": "198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.