Individual provider Active NPI

Mark Allan Toelle, O.D.

  • Optometrist
  • Omaha, NE
National Provider Identifier
1831277367
Registry record updated May 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
NE1146 Issued in NE
Practice address
14450 Eagle Run Dr Ste 140
Omaha, NE 68116
Phone
(402) 884-0776
Fax
(402) 884-0749
NPI assigned
Nov 1, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 29, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NE1146 NE Primary

Addresses

Primary practice location

14450 Eagle Run Dr Ste 140
Omaha, NE 68116

Mailing address

14450 Eagle Run Dr Ste 140
Omaha, NE 68116
Phone (402) 884-0776

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031124000508 NE Practitioner - Optometry 6709799422 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Family Eyecare PCGroup PAC ID 5890608509, 2 clinicians

Practice addresses (Care Compare)

14450 Eagle Run Dr
Suite 140
Omaha, NE 68116-1493
Phone (402) 884-0776

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
NE1146NEMDOptometrist
1146NEMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Family Eyecare PC Optometrist CurrentSince Nov 18, 2002 Accepting new patients
Radiant Family Eyecare LLC Optometrist PastSince Aug 1, 2021 Accepting new patients

Locations

14450 Eagle Run Dr
Ste 140
Omaha, NE 68116
Phone (402) 884-0776

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527552000000",
    "number": "1831277367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14450 EAGLE RUN DR STE 140",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "68116",
            "telephone_number": "402-884-0776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14450 EAGLE RUN DR STE 140",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "68116",
            "telephone_number": "402-884-0776",
            "fax_number": "402-884-0749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOELLE",
        "first_name": "MARK",
        "middle_name": "ALLAN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2018-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NE",
            "license": "NE1146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.