1265578652 NPI number — CLEAR FOCUS EYECARE LLC

Table of content: (NPI 1265578652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265578652 NPI number — CLEAR FOCUS EYECARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEAR FOCUS EYECARE LLC
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:
6
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:
1265578652
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1225 S POPLAR ST
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
NORTH PLATTE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69101-7785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-534-7100
Provider Business Mailing Address Fax Number:
308-534-5002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1225 S POPLAR ST
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
NORTH PLATTE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69101-7785
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-534-7100
Provider Business Practice Location Address Fax Number:
308-534-5002
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GUTSCHENRITTER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
308-534-7100

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  988 , 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: 37138 . This is a "BLUE CROSS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 10025551000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025408200 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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