1710903984 NPI number — BLUFFS VISION CARE, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710903984 NPI number — BLUFFS VISION CARE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLUFFS VISION CARE, PC
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:
1710903984
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
416 VALLEY VIEW DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SCOTTSBLUFF
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69361-1486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-635-1633
Provider Business Mailing Address Fax Number:
308-635-2880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
416 VALLEY VIEW DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SCOTTSBLUFF
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69361-1486
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-635-1633
Provider Business Practice Location Address Fax Number:
308-635-2880
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DARNELL
Authorized Official First Name:
JON
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
308-635-1633

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  01-5420245 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 410024011 . This is a "RAILDROAD ID FOR DR. VANDENBERGE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 506642584 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: CQ4076 . This is a "RAILROAD MEDICARE GROUP ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 410024010 . This is a "RAILRAOD ID FOR DR. KRIEG" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00238913 . This is a "RAILROAD ID FOR DR. DARNELL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 093988 . This is a "MEDICARE GROUP ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1982600441 . This is a "DR. VANDENBERGE/NPI NUMBE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 5071141255 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1215933932 . This is a "DR. KRIEG/NPI NUMBER" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 1265437750 . This is a "DR. DARNELL/NPI NUMBER" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 508566846 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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