=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477510964
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPLETE EYE CARE ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2006
-----------------------------------------------------
Last Update Date | 11/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 SOUTH BAILEY AVE
-----------------------------------------------------
City | NORTH PLATTE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 69101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-534-2000
-----------------------------------------------------
Fax | 308-534-2001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 SOUTH BAILEY AVE
-----------------------------------------------------
City | NORTH PLATTE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 69101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-534-2000
-----------------------------------------------------
Fax | 308-534-2001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JEFFREY T O'CONNOR
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 308-534-2000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------