Provider Demographics
NPI:1679524755
Name:ENGEL, JOSHUA WADE (OD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:WADE
Last Name:ENGEL
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 1:1171 N COTNER BLVD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-1835
Mailing Address - Country:US
Mailing Address - Phone:402-465-5577
Mailing Address - Fax:402-465-0312
Practice Address - Street 1:3400 N 27TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-1314
Practice Address - Country:US
Practice Address - Phone:402-465-5577
Practice Address - Fax:402-465-0312
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1182152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEV04053Medicare UPIN
NE278678Medicare ID - Type Unspecified