Professional Provider Enterprise LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

01891 Issued in IA

Legal business name

PROFESSIONAL PROVIDER ENTERPRISE LLC

Practice address

10826 Old Mill Rd Ste 101
Omaha, NE 68154-2660

Phone

(402) 898-3232

Fax

(402) 898-3234

NPI assigned

Dec 14, 2011

Organization subpart

No

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

Authorized official

Name

John Rosenbaum

Title

Cco

Phone

(913) 647-7926

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IA, WA, OR, NE4 enrollments

Enrollment records 4

Locations (25 of 26)

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Zachary Brown, O.D.

  • Optometrist
  • Omaha, NE
  • NPI 1790048403

  IA

  Medicare reassignment Care Compare group NPD
• Kailey Holzman, OD

  • Optometrist
  • Oregon City, OR
  • NPI 1598656365

  WA

  Medicare reassignment Care Compare group NPD
• Cory James Jensen, OD

  • Optometrist
  • Spokane, WA
  • NPI 1417516279
  Medicare reassignment Care Compare group NPD
• Amanda Joy Korth, OD

  • Optometrist
  • West Union, IA
  • NPI 1013349869
  Medicare reassignment Care Compare group NPD
• Bryan Kent Larson, O.D.

  • Optometrist
  • Humboldt, IA
  • NPI 1356724272
  Medicare reassignment Care Compare group NPD
• Traci May Lee, OD

  • Optometrist
  • Renton, WA
  • NPI 1649342262
  Medicare reassignment Care Compare group NPD
• Ariel A Lenning, OD

  • Optometrist
  • Everett, WA
  • NPI 1629691431
  Medicare reassignment Care Compare group NPD
• Samand Sebghati, O.D.

  • Optometrist
  • Sacramento, CA
  • NPI 1124455639

  WA

  Medicare reassignment Care Compare group NPD
• Shannon Hillier

  • Optometrist
  • Reno, NV
  • NPI 1043664071

  OR, WA

  Medicare reassignment NPD
• Norman Douglas Streifel, O.D.

  • Optometrist
  • Greenwood Village, CO
  • NPI 1275526444

  IA, WA

  Medicare reassignment NPD
• Charles H Vanaki, O.D.

  • Optometrist
  • Edmond, OK
  • NPI 1770896201

  IA

  Medicare reassignment NPD
• Lyndon Graves, OD

  • Optometrist
  • Omaha, NE
  • NPI 1205886736
  Medicare reassignment

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

{
    "created_epoch": "1323820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755820800000",
    "number": "1770852196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10826 OLD MILL RD STE 101",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681542660",
            "telephone_number": "888-840-3032",
            "fax_number": "888-270-3811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10826 OLD MILL RD STE 101",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681542660",
            "telephone_number": "402-898-3232",
            "fax_number": "402-898-3234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL PROVIDER ENTERPRISE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-14",
        "last_updated": "2025-08-22",
        "certification_date": "2025-08-22",
        "status": "A",
        "authorized_official_last_name": "ROSENBAUM",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CCO",
        "authorized_official_telephone_number": "913-647-7926"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IA",
            "license": "01891",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Professional Audiology & Hearing Center Inc
• Professional Audiology and Hearing Center, Inc
• Professional Optical Co.
• Professional Portable Radiologic Services, Inc.
• Professional Provider Company, LLC
• Professional Services of Creighton University Medical Center, LLC
• Professional Veterinary Products LTD
• Profile Orthodontics Omaha LLC
• Progress Physical Therapy, LLC
• Progressive Physical Therapy LLC

• Optometrist in Omaha, NE
• Providers in Omaha, NE by specialty
• Optometrist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.