Provider Demographics
NPI:1750452108
Name:EYECARE ASSOCIATES
Entity Type:Organization
Organization Name:EYECARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:KANT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:308-946-2612
Mailing Address - Street 1:213 1/2 G ST.
Mailing Address - Street 2:P.O. BOX 333
Mailing Address - City:CENTRAL CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68826
Mailing Address - Country:US
Mailing Address - Phone:308-946-2612
Mailing Address - Fax:308-946-2927
Practice Address - Street 1:213 1/2 G ST.
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:NE
Practice Address - Zip Code:68826
Practice Address - Country:US
Practice Address - Phone:308-946-2612
Practice Address - Fax:308-946-2927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE875152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========06Medicaid
NE=========001OtherBLUE CROSS BLUE SHIELD
NE410036281Medicare ID - Type UnspecifiedRAILROAD
NE0349260002Medicare NSC
NE=========001OtherBLUE CROSS BLUE SHIELD
NE098744Medicare ID - Type Unspecified