Provider Demographics
NPI:1023190170
Name:FAMILY EYECARE CENTER,PC
Entity type:Organization
Organization Name:FAMILY EYECARE CENTER,PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:H
Authorized Official - Last Name:STINES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:308-754-5609
Mailing Address - Street 1:624 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:NE
Mailing Address - Zip Code:68873-2023
Mailing Address - Country:US
Mailing Address - Phone:308-754-5609
Mailing Address - Fax:308-754-4338
Practice Address - Street 1:624 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:NE
Practice Address - Zip Code:68873-2023
Practice Address - Country:US
Practice Address - Phone:308-754-5609
Practice Address - Fax:308-754-4338
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY EYECARE CENTER,PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-19
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE0252700001Medicare NSC
NE096584Medicare PIN
NECK3858Medicare PIN