Active NPI
Oregon Trail Eye Center, PC
- Ophthalmology Physician
- Scottsbluff, NE
National Provider Identifier
1659464337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- Legal business name
- OREGON TRAIL EYE CENTER, PC
- Practice address
- 329 West 40TH Street
Scottsbluff, NE 69361-4634 - Phone
- (308) 635-9311
- Fax
- (308) 635-3130
- NPI assigned
- Oct 2, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Barbara J. Miller
- Title
- Administrator
- Phone
- (308) 635-3911
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | NE | Primary |
Addresses
Primary practice location
329 West 40TH Street
Scottsbluff, NE 69361-4634
Mailing address
329 West 40TH Street
Scottsbluff, NE 69361-4634
Phone (308) 635-9311
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10025252500 | Medicaid | NE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NE, WY
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040615001537 | NE | Part B Supplier - Clinic/Group Practice | 9739163924 |
Receives reassigned benefits from 6 practitioners Practice locations: Ainsworth, NE; Grant, NE; Ogallala, NE; Scottsbluff, NE; Sidney, NE; Valentine, NE |
| O20040630000096 | WY | Part B Supplier - Clinic/Group Practice | 9739163924 |
Receives reassigned benefits from 2 practitioners Practice locations: Douglas, WY; Wheatland, WY |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 6
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Ophthalmic Plastic and Reconstructive Surgery Physician
- Edwards, CO
- NPI 1952435919
NE, Ophthalmology
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1659464337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "329 WEST 40TH STREET",
"city": "SCOTTSBLUFF",
"state": "NE",
"postal_code": "693614634",
"telephone_number": "308-635-9311",
"fax_number": "308-635-3130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "329 WEST 40TH STREET",
"city": "SCOTTSBLUFF",
"state": "NE",
"postal_code": "693614634",
"telephone_number": "308-635-9311",
"fax_number": "308-635-3130"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OREGON TRAIL EYE CENTER, PC",
"organizational_subpart": "NO",
"enumeration_date": "2006-10-02",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "MILLER",
"authorized_official_first_name": "BARBARA",
"authorized_official_middle_name": "J.",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "308-635-3911"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Ophthalmology",
"state": "NE",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10025252500",
"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 Aug 22, 2020; 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.