Provider Demographics
NPI:1013107929
Name:HOSPITAL EYE ASSOCIATES LLC
Entity Type:Organization
Organization Name:HOSPITAL EYE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:VANDERVORT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-493-6500
Mailing Address - Street 1:9900 NICHOLAS ST
Mailing Address - Street 2:STE 275
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2249
Mailing Address - Country:US
Mailing Address - Phone:402-493-6500
Mailing Address - Fax:402-493-4370
Practice Address - Street 1:601 N 30TH ST
Practice Address - Street 2:STE 3700
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2137
Practice Address - Country:US
Practice Address - Phone:402-280-4102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1013107929Medicaid
NE10025541400Medicaid
NE10025541400Medicaid