NPIMap

Organization Active NPI

My Family Vision Clinic LLC

  • Optometrist
  • McCook, NE
National Provider Identifier
1043608722
Registry record updated Jan 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1431 Issued in NE
Legal business name
MY FAMILY VISION CLINIC LLC
Practice address
212 W 9TH St
MC Cook, NE 69001-3515
Phone
(308) 345-2954
Fax
(700) 345-7719
NPI assigned
Jan 2, 2015
Last updated
Jan 2, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2015

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

Authorized official

Name
Thomas Moser, O.D.NPI 1821301029
Title
Medical Director
Phone
(308) 345-2954

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1431 NE Primary

Addresses

Primary practice location

212 W 9TH St
MC Cook, NE 69001-3515

Mailing address

212 W 9TH St
MC Cook, NE 69001-3515
Phone (308) 345-2954

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150209000325 NE Part B Supplier - Clinic/Group Practice 8628393915 Receives reassigned benefits from 3 practitioners
Practice locations: MC Cook, NE; Sidney, NE; Benkelman, NE
O20151009000476 NE DME Supplier - Physician - Optometrist 8628393915 Practice locations: McCook, NE

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
My Family Vision Clinic212 W 9TH St, McCook, NE 69001-3515(308) 345-2954 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jan 1, 2015

National Provider Directory

National Provider Directory

Locations

212 W 9th St
McCook, NE 69001
Phone (308) 345-2954

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1420156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420156800000",
    "number": "1043608722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 W 9TH ST",
            "city": "MC COOK",
            "state": "NE",
            "postal_code": "690013515",
            "telephone_number": "308-345-2954",
            "fax_number": "700-345-7719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 W 9TH ST",
            "city": "MC COOK",
            "state": "NE",
            "postal_code": "690013515",
            "telephone_number": "308-345-2954",
            "fax_number": "700-345-7719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY FAMILY VISION CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-02",
        "last_updated": "2015-01-02",
        "status": "A",
        "authorized_official_last_name": "MOSER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "308-345-2954",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NE",
            "license": "1431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McCook, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.