Professional Provider Company, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

PROFESSIONAL PROVIDER COMPANY, LLC

Practice address

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

Phone

(888) 840-3032

Fax

(888) 840-8937

NPI assigned

Oct 20, 2009

Last updated

Mar 17, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lyndon J Graves, OD

Title

Owner

Phone

(888) 840-3032

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1255996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1881920288",
    "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": "888-840-8937"
        },
        {
            "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": "888-840-3032",
            "fax_number": "888-840-8937"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10826 Old Mill Rd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Omaha",
            "state": "NE",
            "postal_code": "681542660",
            "country_code": "US",
            "telephone_number": "888-840-3032",
            "fax_number": "888-840-8937",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROFESSIONAL PROVIDER COMPANY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-20",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "GRAVES",
        "authorized_official_first_name": "LYNDON",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "888-840-3032",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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.