1245226984 NPI number — CHADRON VISION CENTER, INC.

Table of content: (NPI 1245226984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245226984 NPI number — CHADRON VISION CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHADRON VISION CENTER, INC.
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:
CHADRON VISION CENTER
Provider Other Organization Name Type Code:
5
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:
1245226984
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
241 E 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHADRON
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69337-2301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-432-3222
Provider Business Mailing Address Fax Number:
308-432-5344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
241 E 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHADRON
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69337-2301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-432-3222
Provider Business Practice Location Address Fax Number:
308-432-5344
Provider Enumeration Date:
09/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CHANCELLOR
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
OWNER / OPTOMETRIST
Authorized Official Telephone Number:
308-432-3222

Provider Taxonomy Codes

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

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

  • Identifier: 06923 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 09902 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: P00390774 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9203680 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 410017859 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9202140 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06763 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 410046882 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 410046153 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9200910 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9200332 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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