Wakan Vision Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

2277 Issued in CO

Legal business name

WAKAN VISION INC

Practice address

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

Phone

(402) 898-3232

NPI assigned

May 10, 2006

Organization subpart

No

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

Authorized official

Name

Mark A Cooley

Title

President

Phone

(402) 898-3232

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 1

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

• Lyndon Graves, OD

  • Optometrist
  • Omaha, NE
  • NPI 1205886736
  NPD (past)

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1871542241",
    "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": "402-898-3232",
            "fax_number": "402-898-3234"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10826 Old Mill Rd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Omaha",
            "state": "NE",
            "postal_code": "681542660",
            "country_code": "US",
            "telephone_number": "402-898-3232",
            "fax_number": "402-898-3234",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WAKAN VISION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "COOLEY",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "402-898-3232"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CO",
            "license": "2277",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1871542241",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025795600",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33629013",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kevin B Waites Sr.
• Annmarie Wajda
• Bret Wajda
• Walker Nsal Waka
• Wakan Path, LLC
• Amanda Wakefield
• Charles Brent Wakefield II, MD
• Andrew Wakin, APRN - FNP
• Kristin N Wakin, M.D.
• Wal-Mart Stores, Inc

• 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 Mar 17, 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.