Healthcare Provider Details

I. General information

NPI: 1932190527
Provider Name (Legal Business Name): PRAIRIE EYECARE CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 S 8TH AVE
BROKEN BOW NE
68822-2009
US

IV. Provider business mailing address

PO BOX 506 408 S 8TH AVE
BROKEN BOW NE
68822-0506
US

V. Phone/Fax

Practice location:
  • Phone: 308-872-2291
  • Fax: 308-872-3122
Mailing address:
  • Phone: 308-872-2291
  • Fax: 308-872-3122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY W SANGER
Title or Position: OWNER
Credential: O.D.
Phone: 308-872-2291