Provider Demographics
NPI:1710903984
Name:BLUFFS VISION CARE, PC
Entity Type:Organization
Organization Name:BLUFFS VISION CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:M
Authorized Official - Last Name:DARNELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:308-635-1633
Mailing Address - Street 1:416 VALLEY VIEW DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-1486
Mailing Address - Country:US
Mailing Address - Phone:308-635-1633
Mailing Address - Fax:308-635-2880
Practice Address - Street 1:416 VALLEY VIEW DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-1486
Practice Address - Country:US
Practice Address - Phone:308-635-1633
Practice Address - Fax:308-635-2880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE01-5420245152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
410024011OtherRAILDROAD ID FOR DR. VANDENBERGE
NE506642584Medicaid
CQ4076OtherRAILROAD MEDICARE GROUP ID
410024010OtherRAILRAOD ID FOR DR. KRIEG
P00238913OtherRAILROAD ID FOR DR. DARNELL
093988OtherMEDICARE GROUP ID
NE1982600441OtherDR. VANDENBERGE/NPI NUMBE
NE5071141255Medicaid
NE1215933932OtherDR. KRIEG/NPI NUMBER
NE1265437750OtherDR. DARNELL/NPI NUMBER
NE508566846Medicaid
097459Medicare PIN
410024011OtherRAILDROAD ID FOR DR. VANDENBERGE
P00238913OtherRAILROAD ID FOR DR. DARNELL
NE1265437750OtherDR. DARNELL/NPI NUMBER
NET40339Medicare UPIN
NEV01182Medicare UPIN
NE506642584Medicaid