Provider Demographics
NPI:1134142532
Name:GRETNA EYE CARE, P.C.
Entity Type:Organization
Organization Name:GRETNA EYE CARE, P.C.
Other - Org Name:GRETNA VISION SOURCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-332-0220
Mailing Address - Street 1:814 VILLAGE SQ
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-7914
Mailing Address - Country:US
Mailing Address - Phone:402-332-0220
Mailing Address - Fax:402-332-0440
Practice Address - Street 1:814 VILLAGE SQ
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-7914
Practice Address - Country:US
Practice Address - Phone:402-332-0220
Practice Address - Fax:402-332-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1203152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEU98130Medicare UPIN
NE5862960001Medicare NSC