NPIMap

Organization Active NPI

Radiant Family Eyecare LLC

  • Optometrist
  • Elkhorn, NE
National Provider Identifier
1154094316
Registry record updated Jul 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
RADIANT FAMILY EYECARE LLC
Practice address
20330 Veterans Dr Ste 4
Elkhorn, NE 68022-6929
Phone
(402) 885-7695
Fax
(402) 884-2885
NPI assigned
Jul 26, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2021

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

Authorized official

Name
Ginny L Ahrens, ODNPI 1205095353
Title
Owner/Optometrist
Phone
(402) 380-3558

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 MULTIPLE SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

20330 Veterans Dr Ste 4
Elkhorn, NE 68022-6929

Mailing address

1425 N 181St Ave
Elkhorn, NE 68022-3883
Phone (402) 380-3558

Other names 1

  • Advanced Family Eyecare Elkhorn Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210803003256 NE Part B Supplier - Clinic/Group Practice 7719381474 Receives reassigned benefits from 2 practitioners
Practice locations: Elkhorn, NE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1627257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627257600000",
    "number": "1154094316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 N 181ST AVE",
            "city": "ELKHORN",
            "state": "NE",
            "postal_code": "680223883",
            "telephone_number": "402-380-3558",
            "fax_number": "402-884-2885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20330 VETERANS DR STE 4",
            "city": "ELKHORN",
            "state": "NE",
            "postal_code": "680226929",
            "telephone_number": "402-885-7695",
            "fax_number": "402-884-2885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIANT FAMILY EYECARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-26",
        "last_updated": "2021-07-26",
        "certification_date": "2021-07-07",
        "status": "A",
        "authorized_official_last_name": "AHRENS",
        "authorized_official_first_name": "GINNY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "402-380-3558",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Family Eyecare Elkhorn",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Elkhorn, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2021; 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.