NPIMap

Organization Active NPI

International Eyecare Center Inc

Doing business as Malbar Vision

  • Optometrist
  • Omaha, NE
National Provider Identifier
1649451980
Registry record updated Jan 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
INTERNATIONAL EYECARE CENTER INC
Doing business as
Malbar Vision
Practice address
10114 Maple St
Omaha, NE 68134-5555
Phone
(402) 571-8112
Fax
(402) 571-8113
NPI assigned
Nov 15, 2007
Last updated
Jan 22, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2021

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

Authorized official

Name
Cathy Lee Short
Title
Credentialing Manager
Phone
(618) 462-9818

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary
Eyewear Supplier 332H00000X 470486594 NE

Addresses

Primary practice location

10114 Maple St
Omaha, NE 68134-5555

Mailing address

409 N 78TH St
Omaha, NE 68114-3638
Phone (402) 393-4500

Other identifiers 1

IdentifierTypeStateIssuer
47048659405MedicaidNE

Other names 1

  • Malbar Vision Doing business as

National Provider Directory

National Provider Directory
Tax ID family
International Eyecare Center Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1195084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611273600000",
    "number": "1649451980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 N 78TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681143638",
            "telephone_number": "402-393-4500",
            "fax_number": "402-393-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10114 MAPLE ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681345555",
            "telephone_number": "402-571-8112",
            "fax_number": "402-571-8113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNATIONAL EYECARE CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-15",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A",
        "authorized_official_last_name": "SHORT",
        "authorized_official_first_name": "CATHY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "618-462-9818"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NE",
            "license": "470486594",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47048659405",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Malbar Vision",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2021; 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.