Provider Demographics
NPI:1245420785
Name:EXCLUSIVELY EYECARE LLC
Entity Type:Organization
Organization Name:EXCLUSIVELY EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-493-8266
Mailing Address - Street 1:13104 W DODGE RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2150
Mailing Address - Country:US
Mailing Address - Phone:402-493-8266
Mailing Address - Fax:402-493-7085
Practice Address - Street 1:13104 W DODGE RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2150
Practice Address - Country:US
Practice Address - Phone:402-493-8266
Practice Address - Fax:402-493-7085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE950152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE098634Medicare UPIN