NPIMap

Organization Active NPI

Lake Avenue Eyecare LLC

  • Eyewear Supplier
  • Gothenburg, NE
National Provider Identifier
1396932430
Registry record updated Oct 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
License
1166 Issued in NE
Legal business name
LAKE AVENUE EYECARE LLC
Practice address
829 Lake Ave
Gothenburg, NE 69138-1943
Phone
(308) 537-3390
Fax
(308) 537-3391
NPI assigned
Oct 3, 2007
Last updated
Oct 27, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2022

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

Authorized official

Name
Dr. John A Gosnell, O.D.NPI 1962458612
Title
Owner
Phone
(308) 537-3390

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X 1166 NE Primary
Optometrist 152W00000X 1166 NE

Addresses

Primary practice location

829 Lake Ave
Gothenburg, NE 69138-1943

Mailing address

829 Lake Ave
Gothenburg, NE 69138-1943
Phone (308) 537-3390

Other identifiers 3

IdentifierTypeStateIssuer
10024987700MedicaidNE
06754OtherBLUE CROSS BLUE SHIELDPIN
240481OtherMIDLANDS CHOICE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1191369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666828800000",
    "number": "1396932430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "829 LAKE AVE",
            "city": "GOTHENBURG",
            "state": "NE",
            "postal_code": "691381943",
            "telephone_number": "308-537-3390",
            "fax_number": "308-537-3391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "829 LAKE AVE",
            "city": "GOTHENBURG",
            "state": "NE",
            "postal_code": "691381943",
            "telephone_number": "308-537-3390",
            "fax_number": "308-537-3391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE AVENUE EYECARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-03",
        "last_updated": "2022-10-27",
        "certification_date": "2022-10-27",
        "status": "A",
        "authorized_official_last_name": "GOSNELL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "308-537-3390",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NE",
            "license": "1166",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NE",
            "license": "1166",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10024987700",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELDPIN",
            "identifier": "06754",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIDLANDS CHOICE",
            "identifier": "240481",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gothenburg, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.