Healthcare Provider Details

I. General information

NPI: 1992865356
Provider Name (Legal Business Name): EYECARE ASSOCIATES OF COLUMBUS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
SCHUYLER NE
68661-1300
US

IV. Provider business mailing address

1 HOSPITAL DR PO BOX 516
SCHUYLER NE
68661-1300
US

V. Phone/Fax

Practice location:
  • Phone: 402-352-3855
  • Fax: 402-352-3869
Mailing address:
  • Phone: 402-352-3855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1069
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1091
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number801
License Number StateNE

VIII. Authorized Official

Name: DR. DANIEL K MICKEY
Title or Position: OWNER
Credential: OD
Phone: 402-352-3855