Provider Demographics
NPI:1497817241
Name:GUTSHALL KOHLE PELSTER EYECARE, LLC
Entity Type:Organization
Organization Name:GUTSHALL KOHLE PELSTER EYECARE, LLC
Other - Org Name:GUTSHALL KOHLE PELSTER EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:C
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:GUTSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-336-2505
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-0378
Mailing Address - Country:US
Mailing Address - Phone:402-336-2505
Mailing Address - Fax:402-336-3506
Practice Address - Street 1:214 N 10TH ST
Practice Address - Street 2:
Practice Address - City:ONEILL
Practice Address - State:NE
Practice Address - Zip Code:68763-1604
Practice Address - Country:US
Practice Address - Phone:402-336-2505
Practice Address - Fax:402-336-2505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE6014870001Medicare NSC
NE099963Medicare PIN