Provider Demographics
NPI:1720012669
Name:MIDTOWN EYECARE INC
Entity Type:Organization
Organization Name:MIDTOWN EYECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MONSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-553-1999
Mailing Address - Street 1:5011 GROVER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-3830
Mailing Address - Country:US
Mailing Address - Phone:402-553-1999
Mailing Address - Fax:402-553-1930
Practice Address - Street 1:5011 GROVER ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3830
Practice Address - Country:US
Practice Address - Phone:402-553-1999
Practice Address - Fax:402-553-1930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE36364OtherBCBS
NE=========00Medicaid
NE410049297Medicare PIN
NE099298Medicare PIN
NE36364OtherBCBS
NE4568510001Medicare NSC