1972671881 NPI number — EYECARE ASSOCIATES OF COLUMBUS PC

Table of content: (NPI 1972671881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972671881 NPI number — EYECARE ASSOCIATES OF COLUMBUS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYECARE ASSOCIATES OF COLUMBUS 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:
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:
1972671881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1248
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68602-1248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-564-0545
Provider Business Mailing Address Fax Number:
402-564-0078

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1371 29TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68601-4926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-564-0545
Provider Business Practice Location Address Fax Number:
402-564-0078
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MALICKY
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
402-564-0545

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1069 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 1091 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 801 , 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: 06952 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: N001920 . This is a "CHAMPUS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 06731 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: CH1483 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 36395 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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