Provider Demographics
NPI:1265578652
Name:CLEAR FOCUS EYECARE LLC
Entity type:Organization
Organization Name:CLEAR FOCUS EYECARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GUTSCHENRITTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:308-534-7100
Mailing Address - Street 1:1225 S POPLAR ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-7785
Mailing Address - Country:US
Mailing Address - Phone:308-534-7100
Mailing Address - Fax:308-534-5002
Practice Address - Street 1:1225 S POPLAR ST
Practice Address - Street 2:SUITE 400
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-7785
Practice Address - Country:US
Practice Address - Phone:308-534-7100
Practice Address - Fax:308-534-5002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE988152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE37138OtherBLUE CROSS
NE10025551000Medicaid
NE10025408200Medicaid
NE10025551000Medicaid
NE158106Medicare UPIN
NE280110Medicare ID - Type Unspecified