Provider Demographics
NPI:1932190527
Name:PRAIRIE EYECARE CENTER PC
Entity Type:Organization
Organization Name:PRAIRIE EYECARE CENTER PC
Other - Org Name:PRAIRIE EYECARE CENTER LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:SANGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:308-872-2291
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:408 S 8TH AVE
Mailing Address - City:BROKEN BOW
Mailing Address - State:NE
Mailing Address - Zip Code:68822-0506
Mailing Address - Country:US
Mailing Address - Phone:308-872-2291
Mailing Address - Fax:308-872-3122
Practice Address - Street 1:408 S 8TH AVE
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:NE
Practice Address - Zip Code:68822-2009
Practice Address - Country:US
Practice Address - Phone:308-872-2291
Practice Address - Fax:308-872-3122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47077269013Medicaid
NEC04190OtherPALMETTO GBA RAILROAD MED
NEDN0887OtherRR MEDICARE PTAN
NE10025628100Medicaid
NENA1061Medicare PIN
NE47077269013Medicaid
NE0723900001Medicare NSC
NEC04190OtherPALMETTO GBA RAILROAD MED