Provider Demographics
NPI:1437200961
Name:ONEILL FAMILY EYECARE PC
Entity Type:Organization
Organization Name:ONEILL FAMILY EYECARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:LYLE
Authorized Official - Last Name:GILDERSLEEVE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-336-2220
Mailing Address - Street 1:612 N 4TH ST
Mailing Address - Street 2:P.O. BOX 818
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-1326
Mailing Address - Country:US
Mailing Address - Phone:402-336-2220
Mailing Address - Fax:402-336-4845
Practice Address - Street 1:612 N 4TH ST
Practice Address - Street 2:
Practice Address - City:ONEILL
Practice Address - State:NE
Practice Address - Zip Code:68763-1326
Practice Address - Country:US
Practice Address - Phone:402-336-2220
Practice Address - Fax:402-336-4845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEDG0428OtherRR MEDICARE
NE5883720001Medicare NSC
NE099944Medicare PIN