=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972796845
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J KEVIN BELVILLE, MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2007
-----------------------------------------------------
Last Update Date | 10/31/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1414 W 12TH ST
-----------------------------------------------------
City | HASTINGS
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68901-3742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-462-9191
-----------------------------------------------------
Fax | 402-462-9192
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1414 W 12TH ST
-----------------------------------------------------
City | HASTINGS
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68901-3742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-462-9191
-----------------------------------------------------
Fax | 402-462-9192
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTHALMOLOGIST/PRESIDENT
-----------------------------------------------------
Name | DR. J. KEVIN BELVILLE
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 402-462-9191
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number | 138365
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 14789
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------