NPIMap

Organization Active NPI

Pediatric Ophthalmology Associates, P.C.

  • Specialist
  • Omaha, NE
National Provider Identifier
1003080938
Registry record updated Aug 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
PEDIATRIC OPHTHALMOLOGY ASSOCIATES, P.C.
Practice address
515 N 98TH St
Omaha, NE 68114-2368
Phone
(402) 399-9400
Fax
(402) 399-8170
NPI assigned
Apr 22, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Dylan M Stoffer
Title
Credentialing & Contracting Manager
Phone
(402) 399-9400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

515 N 98TH St
Omaha, NE 68114-2368

Mailing address

515 N 98TH St
Omaha, NE 68114-2368
Phone (402) 399-9400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150811004247 NE Part B Supplier - Clinic/Group Practice 2961717640 Receives reassigned benefits from 4 practitioners
Practice locations: Omaha, NE

National Provider Directory

National Provider Directory

Locations

8901 Indian Hills Dr
Ste 200
Omaha, NE 68114
Phone (402) 397-7057

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661126400000",
    "number": "1003080938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 N 98TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681142368",
            "telephone_number": "402-399-9400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 N 98TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681142368",
            "telephone_number": "402-399-9400",
            "fax_number": "402-399-8170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC OPHTHALMOLOGY ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-22",
        "last_updated": "2022-08-22",
        "certification_date": "2022-08-22",
        "status": "A",
        "authorized_official_last_name": "STOFFER",
        "authorized_official_first_name": "DYLAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING & CONTRACTING MANAGER",
        "authorized_official_telephone_number": "402-399-9400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.