NPIMap

Organization Active NPI

Scottsbluff Vision Clinic PC

  • Optometrist
  • Scottsbluff, NE
National Provider Identifier
1467570473
Registry record updated Jul 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
905 Issued in NE
Legal business name
SCOTTSBLUFF VISION CLINIC PC
Practice address
3726 Avenue D
Scottsbluff, NE 69361-4665
Phone
(308) 635-1234
Fax
(308) 635-7505
NPI assigned
Mar 27, 2007
Last updated
Jul 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2022

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

Authorized official

Name
Laura Beth Myers
Title
Office Manager
Phone
(308) 635-1234

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 905 NE Primary

Addresses

Primary practice location

3726 Avenue D
Scottsbluff, NE 69361-4665

Mailing address

3726 Avenue D
Scottsbluff, NE 69361-4665
Phone (308) 635-1234

Other identifiers 1

IdentifierTypeStateIssuer
7647OtherNEBLUE CROSS BLUE SHIELD

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070918000596 NE Part B Supplier - Clinic/Group Practice 9931181880 Receives reassigned benefits from 4 practitioners
Practice locations: Scottsbluff, NE
O20100930093289 NE DME Supplier - Physician - OptometristDME Supplier - Optician 9931181880 Practice locations: Scottsbluff, NE

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
Scottsbluff Vision Clinic PC3726 Avenue D, Scottsbluff, NE 69361-4665(308) 635-1234 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Aug 1, 2000

National Provider Directory

National Provider Directory
Tax ID family
Scottsbluff Vision Clinic P2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3726 Avenue D
Scottsbluff, NE 69361
Phone (308) 635-1234

Interoperability endpoints

  • Direct secure messaging: njenkins@sbvc.eyefinity-direct.com
  • Direct secure messaging: pcolburn@sbvc.eyefinity-direct.com

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": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657843200000",
    "number": "1467570473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3726 AVENUE D",
            "city": "SCOTTSBLUFF",
            "state": "NE",
            "postal_code": "693614665",
            "telephone_number": "308-635-1234",
            "fax_number": "308-635-7505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3726 AVENUE D",
            "city": "SCOTTSBLUFF",
            "state": "NE",
            "postal_code": "693614665",
            "telephone_number": "308-635-1234",
            "fax_number": "308-635-7505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCOTTSBLUFF VISION CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-15",
        "status": "A",
        "authorized_official_last_name": "MYERS",
        "authorized_official_first_name": "LAURA BETH",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "308-635-1234"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NE",
            "license": "905",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "7647",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Scottsbluff, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2022; 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.