1942333190 NPI number — BLUFFS VISION CARE, PC

Table of content: (NPI 1942333190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942333190 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:
KIMBALL VISION CLINIC
Provider Other Organization Name Type Code:
3
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:
1942333190
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2008
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 # 100
Provider Second Line Business Mailing Address:
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:
112 S CHESTNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIMBALL
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69145-1257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-235-3649
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KRIEG
Authorized Official First Name:
JACOB
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
308-635-1633

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  876 , 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: 1215933932 . This is a "INDIVIDUAL NPI #" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 1710903984 . This is a "GROUP NPI FOR BVC" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 506642584 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".