Elkhorn Ridge Vision PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

1178 Issued in NE

Legal business name

ELKHORN RIDGE VISION PC

Practice address

304 N. 179TH Street
Suite 203
Omaha, NE 68118-3569

Phone

(402) 614-4322

Fax

(402) 614-4475

NPI assigned

Jul 21, 2006

Organization subpart

No

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

Authorized official

Name

Matthew F Klemke, O.D.NPI 1811918360

Title

President

Phone

(402) 614-4322

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NE

Enrollment records 1

Tax ID family

Elkhorn Ridge Vision PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Elkhorn Ridge Vision PC

  • Optometrist
  • Omaha, NE
  • NPI 1316586464
  NPD tax ID

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Elkhorn Ridge Vision PC

  • Optometrist
  • Omaha, NE
  • NPI 1316586464
  NPPES parent name

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Matthew F Klemke, O.D.

  • Optometrist
  • Omaha, NE
  • NPI 1811918360

  NE

  Medicare reassignment Care Compare group Authorized official
• Ariann Brown, OD

  • Optometrist
  • Omaha, NE
  • NPI 1982666715

  NE

  Medicare reassignment Care Compare group
• Jacob Daniel Nordhues, OD

  • Optometrist
  • Omaha, NE
  • NPI 1659881241

  NE

  Medicare reassignment Care Compare group
• Michelle Katherine Allen, OD, MS

  • Optometrist
  • Omaha, NE
  • NPI 1770417198

  NE

  Medicare reassignment
• Dustin Strasburg, O.D.

  • Optometrist
  • Omaha, NE
  • NPI 1700238326

  NE

  Medicare reassignment
• Alex Michael Van Kooten-Tharman, O.D.

  • Optometrist
  • Omaha, NE
  • NPI 1801549506

  NE

  Medicare reassignment
• Tammy Sue Richert, O.D.

  • Optometrist
  • Omaha, NE
  • NPI 1225075591
  NPD (past)

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577923200000",
    "number": "1871514331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 N. 179TH STREET",
            "address_2": "SUITE 203",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681183569",
            "telephone_number": "402-614-4322",
            "fax_number": "402-614-4475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 N. 179TH STREET",
            "address_2": "SUITE 203",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681183569",
            "telephone_number": "402-614-4322",
            "fax_number": "402-614-4475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELKHORN RIDGE VISION PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2020-01-02",
        "certification_date": "2020-01-02",
        "status": "A",
        "authorized_official_last_name": "KLEMKE",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "402-614-4322",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NE",
            "license": "1178",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "37054",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE DD2869",
            "identifier": "P00219077",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elite Professionals Home Care LLC
• Elizabazd Diing
• Elizabeth a Potter PC
• Elizabeth'S Luxury Home Healthcare
• Elkhorn Ridge Vision PC
• Julia Amy Elkin
• Karen Leigh Elkins, PLMHP
• Johnny Ellebb
• Jeanne Ellefson, MS, CCC-SLP
• Jennifer Ann Eller

• All providers in Omaha, NE
• Optometrist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 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.

Verify at the official NPI Registry.