Basic Information
| Provider Information | |||||||||
| NPI: | 1821010521 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EYECARE SPECIALTIES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7930 O ST | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024202020 | ||||||||
| FaxNumber: | 4023232002 | ||||||||
| Practice Location | |||||||||
| Address1: | 2943 PINELAKE RD | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024202020 | ||||||||
| FaxNumber: | 4023232089 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 10/12/2009 | ||||||||
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| AuthorizedOfficialLastName: | SIMPSON | ||||||||
| AuthorizedOfficialFirstName: | ANDREA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS/FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 4024202020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | NE | Y | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 0553580001 | 01 | NE | DMERC | OTHER |