Provider Demographics
NPI:1740455260
Name:ADVANCED FAMILY EYECARE PC
Entity type:Organization
Organization Name:ADVANCED FAMILY EYECARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOELLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-884-0776
Mailing Address - Street 1:14450 EAGLE RUN DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-1493
Mailing Address - Country:US
Mailing Address - Phone:402-884-0776
Mailing Address - Fax:402-884-0749
Practice Address - Street 1:14450 EAGLE RUN DR
Practice Address - Street 2:SUITE 140
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-1493
Practice Address - Country:US
Practice Address - Phone:402-884-0776
Practice Address - Fax:402-884-0749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE1146152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE277050Medicare PIN
NEU78554Medicare UPIN