Provider Demographics
NPI:1831478338
Name:URBAN EYES PC
Entity Type:Organization
Organization Name:URBAN EYES PC
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERBOLSHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-932-8007
Mailing Address - Street 1:3906 TWIN CREEK DR
Mailing Address - Street 2:STE 102
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-4104
Mailing Address - Country:US
Mailing Address - Phone:402-932-8007
Mailing Address - Fax:402-932-8112
Practice Address - Street 1:3906 TWIN CREEK DR
Practice Address - Street 2:STE 102
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-4104
Practice Address - Country:US
Practice Address - Phone:402-932-8007
Practice Address - Fax:402-932-8112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-15
Last Update Date:2011-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1217152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026095700Medicaid