Provider Demographics
NPI:1245574615
Name:BOLEN EIGENBERG PC
Entity type:Organization
Organization Name:BOLEN EIGENBERG PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:308-440-3837
Mailing Address - Street 1:1918 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-4704
Mailing Address - Country:US
Mailing Address - Phone:308-832-0144
Mailing Address - Fax:
Practice Address - Street 1:110 E HAWTHORNE ST
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NE
Practice Address - Zip Code:68959-1971
Practice Address - Country:US
Practice Address - Phone:308-832-0144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-25
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1292152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty