Provider Demographics
NPI:1992865356
Name:EYECARE ASSOCIATES OF COLUMBUS PC
Entity Type:Organization
Organization Name:EYECARE ASSOCIATES OF COLUMBUS PC
Other - Org Name:SUBCHAPTER S CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:MICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-352-3855
Mailing Address - Street 1:1 HOSPITAL DR
Mailing Address - Street 2:PO BOX 516
Mailing Address - City:SCHUYLER
Mailing Address - State:NE
Mailing Address - Zip Code:68661-1300
Mailing Address - Country:US
Mailing Address - Phone:402-352-3855
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SCHUYLER
Practice Address - State:NE
Practice Address - Zip Code:68661-1300
Practice Address - Country:US
Practice Address - Phone:402-352-3855
Practice Address - Fax:402-352-3869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE801152W00000X
NE1069152W00000X
NE1091152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE06731OtherBCBS
NE36395OtherBCBS
NE06952OtherBCBS
CH1483OtherRAILROAD MEDICARE GROUP
NECHAMPUSOtherN001930
NE=========00Medicaid
NE06952OtherBCBS
NE099084Medicare ID - Type Unspecified
NE094006Medicare ID - Type Unspecified
NE=========00Medicaid
NE06731OtherBCBS
NE57090Medicare UPIN
NE266987Medicare ID - Type Unspecified