NPIMap

Organization Active NPI

Legacy Eyecare, LLC

  • Optometrist
  • Omaha, NE
National Provider Identifier
1790718328
Registry record updated Mar 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1254 Issued in NE
Legal business name
LEGACY EYECARE, LLC
Practice address
17520 Wright St Ste 105
Omaha, NE 68130-4657
Phone
(402) 614-3200
Fax
(402) 614-7070
NPI assigned
Jul 8, 2006
Last updated
Mar 26, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2009

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

Authorized official

Name
Jeffrey John Brewer, O.D.NPI 1346273976
Title
President
Phone
(402) 614-3200

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 1254 NE Primary

Addresses

Primary practice location

17520 Wright St Ste 105
Omaha, NE 68130-4657

Mailing address

17520 Wright St Ste 105
Omaha, NE 68130-4657
Phone (402) 614-3200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061102000188 NE Part B Supplier - Clinic/Group Practice 2466459524 Receives reassigned benefits from 2 practitioners
Practice locations: Omaha, NE; Elkhorn, NE

National Provider Directory

National Provider Directory

Locations

18924 Evans St
Ste 104
Elkhorn, NE 68022
Phone (402) 614-3200

16949 Lakeside Hills Plz
Omaha, NE 68130

16949 Lakeside Hills Plz
Ste 101
Omaha, NE 68130
Phone (402) 614-3200

Practitioners & affiliated clinicians

Practitioners 10

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": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238025600000",
    "number": "1790718328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17520 WRIGHT ST STE 105",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681304657",
            "telephone_number": "402-614-3200",
            "fax_number": "402-614-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17520 WRIGHT ST STE 105",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681304657",
            "telephone_number": "402-614-3200",
            "fax_number": "402-614-7070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY EYECARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2009-03-26",
        "status": "A",
        "authorized_official_last_name": "BREWER",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "402-614-3200",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NE",
            "license": "1254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Mar 26, 2009; 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.

Verify at the official NPI Registry.