NPIMap

Organization Active NPI

Expert Eyecare Shadow Lake, PC

  • Optometrist
  • Papillion, NE
National Provider Identifier
1619121027
Registry record updated Jul 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
NE1064 Issued in NE
Legal business name
EXPERT EYECARE SHADOW LAKE, PC
Practice address
7474 Towne Center Pkwy
Suite # 107
Papillion, NE 68046-4805
Phone
(402) 592-3266
Fax
(402) 592-3249
NPI assigned
Nov 12, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2009

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

Authorized official

Name
Dr. Michael Martin Young, O.DNPI 1700902822
Title
Owner
Phone
(402) 393-5876

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 NE1064 NE Primary

Addresses

Primary practice location

7474 Towne Center Pkwy
Suite # 107
Papillion, NE 68046-4805

Mailing address

7474 Towne Center Pkwy
Suite # 107
Papillion, NE 68046-4805
Phone (402) 592-3266

Other names 1

  • Professional Eyecare Shadow Lake Doing business as

National Provider Directory

National Provider Directory

Locations

7474 Towne Center Pkwy
Ste 107
Papillion, NE 68046
Phone (402) 592-3239

Practitioners & affiliated clinicians

Practitioners 1

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": "1226448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247443200000",
    "number": "1619121027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7474 TOWNE CENTER PKWY",
            "address_2": "SUITE # 107",
            "city": "PAPILLION",
            "state": "NE",
            "postal_code": "680464805",
            "telephone_number": "402-592-3266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7474 TOWNE CENTER PKWY",
            "address_2": "SUITE # 107",
            "city": "PAPILLION",
            "state": "NE",
            "postal_code": "680464805",
            "telephone_number": "402-592-3266",
            "fax_number": "402-592-3249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXPERT EYECARE SHADOW LAKE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-12",
        "last_updated": "2009-07-13",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "MARTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "402-393-5876",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NE",
            "license": "NE1064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Professional Eyecare Shadow Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Papillion, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2009; 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.