1710903984 NPI number — BLUFFS VISION CARE, PC

Table of content: (NPI 1710903984)

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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