Provider Demographics
NPI:1881690261
Name:SUTTON SKIN AND EYE CLINIC PC
Entity Type:Organization
Organization Name:SUTTON SKIN AND EYE CLINIC PC
Other - Org Name:SUTTON DERMATOLOGY AND AESTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:K
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-484-9009
Mailing Address - Street 1:PO BOX 6068
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-0068
Mailing Address - Country:US
Mailing Address - Phone:402-484-9009
Mailing Address - Fax:402-483-4223
Practice Address - Street 1:7100 STEPHANIE LN STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5332
Practice Address - Country:US
Practice Address - Phone:402-484-9009
Practice Address - Fax:402-483-4223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CU0481OtherRAILROAD MEDICARE GROUP
CU0481OtherRAILROAD MEDICARE GROUP
098957Medicare PIN