MEDICARE: ROGER C. MC CARTNEY, O.D.,AND BRANDON A. BLAIR, O.D.,P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WL0500X	Low Vision Rehabilitation Optometrist
2	152W00000X	Optometrist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410044452	OTHER	NE	RAIL ROAD MEDICARE

General Provider Information

NPI Number	:	1396813200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROGER C. MC CARTNEY, O.D.,AND BRANDON A. BLAIR, O.D.,P.C.

Provider Business Mailing Address
First Line	:	132 N. 8TH ST.
Second Line	:
City	:	LOUP CITY
State	:	NE
Zip	:	68853-8065
Country	:	US
Telephone Number	:	308-745-0803
Fax Number	:	308-745-0803

Provider Business Practice Location Address
First Line	:	132 N. 8TH ST.
Second Line	:
City	:	LOUP CITY
State	:	NE
Zip	:	68853-8065
Country	:	US
Telephone Number	:	308-745-0803
Fax Number	:	308-745-0803

Authorized Official
Title or Position	:	CEO
Name	:	DR. ROGER C MCCARTNEY
Credential	:	O.D.
Telephone Number	:	308-745-0803

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	11/26/2012

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