1174249833 NPI number — EYE PHYSICIANS, P.C.

Table of content: (NPI 1174249833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174249833 NPI number — EYE PHYSICIANS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE PHYSICIANS, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174249833
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1275
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68602-1275
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-563-3686
Provider Business Mailing Address Fax Number:
402-563-3084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2501 W BENJAMIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68701-3119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-371-3158
Provider Business Practice Location Address Fax Number:
402-371-3466
Provider Enumeration Date:
10/14/2022

Additional Information

Authorized Official

Authorized Official Last Name:
DIEDRICHSEN
Authorized Official First Name:
RUTH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
BILLING / HR
Authorized Official Telephone Number:
402-563-3686

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10026610706 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026610707 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com