Provider Demographics
NPI:1821014424
Name:DORSEY EYECARE PC
Entity Type:Organization
Organization Name:DORSEY EYECARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:DORSEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:308-728-7700
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:ORD
Mailing Address - State:NE
Mailing Address - Zip Code:68862-0100
Mailing Address - Country:US
Mailing Address - Phone:308-728-7700
Mailing Address - Fax:
Practice Address - Street 1:314 S 14TH ST STE 202
Practice Address - Street 2:
Practice Address - City:ORD
Practice Address - State:NE
Practice Address - Zip Code:68862-1755
Practice Address - Country:US
Practice Address - Phone:308-728-7700
Practice Address - Fax:308-728-7720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025446300Medicaid
NE099845Medicare ID - Type Unspecified
NE5794900001Medicare NSC