Provider Demographics
NPI:1821296203
Name:LEXINGTON FAMILY EYECARE
Entity Type:Organization
Organization Name:LEXINGTON FAMILY EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:308-324-5631
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68850
Mailing Address - Country:US
Mailing Address - Phone:308-324-5631
Mailing Address - Fax:308-324-3096
Practice Address - Street 1:801 NORTH GRANT STREET
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NE
Practice Address - Zip Code:68850
Practice Address - Country:US
Practice Address - Phone:308-324-5631
Practice Address - Fax:308-324-3096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE094361Medicare PIN
NE=========00Medicaid