Provider Demographics
NPI:1285843151
Name:PROFESSIONAL EYECARE OAKVIEW, INC
Entity Type:Organization
Organization Name:PROFESSIONAL EYECARE OAKVIEW, INC
Other - Org Name:PROEYE VISION CENTER OMAHA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:GEISERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-817-5626
Mailing Address - Street 1:12744 WESTPORT PKWY STE 1E
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68138-4017
Mailing Address - Country:US
Mailing Address - Phone:402-502-1228
Mailing Address - Fax:402-502-1232
Practice Address - Street 1:12744 WESTPORT PKWY STE 1E
Practice Address - Street 2:
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68138-4017
Practice Address - Country:US
Practice Address - Phone:402-502-1228
Practice Address - Fax:402-502-1232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE36761OtherBXBS
NE098698PRMedicare ID - Type Unspecified