Provider Demographics
NPI:1174614200
Name:POLZIEN, DUANE E (OD)
Entity type:Individual
Prefix:DR
First Name:DUANE
Middle Name:E
Last Name:POLZIEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 O STREET
Mailing Address - Street 2:#127
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2460
Mailing Address - Country:US
Mailing Address - Phone:402-466-4111
Mailing Address - Fax:402-466-4202
Practice Address - Street 1:6900 O STREET
Practice Address - Street 2:#127
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2460
Practice Address - Country:US
Practice Address - Phone:402-466-4111
Practice Address - Fax:402-466-4202
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE757152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47080172500Medicaid
NE100025846400Medicaid
NE6372880001Medicare NSC
NE47080172500Medicaid
NENA1488002Medicare PIN
T71406Medicare UPIN
NE100025846400Medicaid