NPIMap

Organization Active NPI

Tiburon Family Eyecare, PC

  • Optometrist
  • Gretna, NE
National Provider Identifier
1285971994
Registry record updated Apr 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1277 Issued in NE
Legal business name
TIBURON FAMILY EYECARE, PC
Practice address
11314 Wickersham Blvd
Ste. 300
Gretna, NE 68028-6989
Phone
(402) 933-5775
NPI assigned
Jan 15, 2013
Last updated
Apr 17, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2013

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

Authorized official

Name
Bradley J CarpenterNPI 1144427451
Title
Owner/Optometrist
Phone
(402) 933-5775

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 1277 NE Primary

Addresses

Primary practice location

11314 Wickersham Blvd
Ste. 300
Gretna, NE 68028-6989

Mailing address

11314 Wickersham Blvd
Ste. 300
Gretna, NE 68028-6989
Phone (402) 933-5775

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130508000494 NE Part B Supplier - Clinic/Group Practice 8022255181 Receives reassigned benefits from 3 practitioners
Practice locations: Gretna, NE

National Provider Directory

National Provider Directory

Locations

11314 Wickersham Blvd
Ste 300
Gretna, NE 68028
Phone (402) 933-5775

Practitioners & affiliated clinicians

Practitioners 4

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": "1358208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366156800000",
    "number": "1285971994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11314 WICKERSHAM BLVD",
            "address_2": "STE. 300",
            "city": "GRETNA",
            "state": "NE",
            "postal_code": "680286989",
            "telephone_number": "402-933-5775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11314 WICKERSHAM BLVD",
            "address_2": "STE. 300",
            "city": "GRETNA",
            "state": "NE",
            "postal_code": "680286989",
            "telephone_number": "402-933-5775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIBURON FAMILY EYECARE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-15",
        "last_updated": "2013-04-17",
        "status": "A",
        "authorized_official_last_name": "CARPENTER",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "402-933-5775"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NE",
            "license": "1277",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gretna, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2013; 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.