Provider Demographics
NPI:1972978435
Name:PROEYE GROUP SHADOW LAKE, P.C.
Entity type:Organization
Organization Name:PROEYE GROUP SHADOW LAKE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:GEISERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-730-4842
Mailing Address - Street 1:443 ROAD 4600
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:NE
Mailing Address - Zip Code:68943-8835
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7474 TOWNE CENTER PKWY
Practice Address - Street 2:SUITE 107
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4805
Practice Address - Country:US
Practice Address - Phone:402-592-3266
Practice Address - Fax:402-592-3249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE944152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty