Healthcare Provider Details

I. General information

NPI: 1750360897
Provider Name (Legal Business Name): MIDWEST EYE CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4353 DODGE ST
OMAHA NE
68131-2709
US

IV. Provider business mailing address

4353 DODGE ST
OMAHA NE
68131-2709
US

V. Phone/Fax

Practice location:
  • Phone: 402-552-2020
  • Fax: 402-552-2367
Mailing address:
  • Phone: 402-552-2020
  • Fax: 402-552-2367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAY SLAGLE
Title or Position: CEO/ADMINISTRATOR
Credential:
Phone: 402-552-2020