Provider Demographics
NPI:1588849848
Name:VISION CARE CLINIC PC
Entity Type:Organization
Organization Name:VISION CARE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOWKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-263-2020
Mailing Address - Street 1:210 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:NE
Mailing Address - Zip Code:68008-2055
Mailing Address - Country:US
Mailing Address - Phone:402-426-2119
Mailing Address - Fax:402-426-2120
Practice Address - Street 1:210 S 17TH ST
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:NE
Practice Address - Zip Code:68008-2055
Practice Address - Country:US
Practice Address - Phone:402-426-2119
Practice Address - Fax:402-426-2120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01624152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEA004235OtherCHAMPUS
NE1588849848Medicaid
NE421497919OtherCOMMERCIAL & OTHER STATES
NE1588849848Medicaid
NENA1038Medicare PIN