Provider Demographics
NPI:1770505265
Name:EYECARE SPECIALTIES PC
Entity Type:Organization
Organization Name:EYECARE SPECIALTIES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS/FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-420-2020
Mailing Address - Street 1:7930 O ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510
Mailing Address - Country:US
Mailing Address - Phone:402-420-2020
Mailing Address - Fax:402-323-2002
Practice Address - Street 1:2500 NORTHVIEW RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521
Practice Address - Country:US
Practice Address - Phone:402-420-2020
Practice Address - Fax:402-323-2028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE0553580001OtherDMERC
NE0553580001OtherDMERC
NE=========13Medicaid