Active NPI
Provision Eye Care LLC
- Optometrist
- Omaha, NE
National Provider Identifier
1902256647
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 960
- Legal business name
- PROVISION EYE CARE LLC
- Practice address
- 713 N 114TH St
Omaha, NE 68154-1515 - Phone
- (402) 991-3131
- NPI assigned
- Jun 14, 2016
- 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
- Dr. Daniel Mark Jackson, O.D.
- Title
- Owner
- Phone
- (402) 991-3131
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 960 | NE | Primary |
Addresses
Primary practice location
713 N 114TH St
Omaha, NE 68154-1515
Mailing address
713 N 114TH St
Omaha, NE 68154-1515
Phone (402) 991-3131
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00393695 | Other | NE | RR MEDICARE |
| 10025388400 | Medicaid | NE | |
| 904415 | Other | NE | SHARE ADVANTAGE |
| 37154 | Other | NE | BCBS |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Optometrist
- Omaha, NE
- NPI 1972502391
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1465862400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1467763200000",
"number": "1902256647",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "713 N 114TH ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681541515",
"telephone_number": "402-991-3131"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "713 N 114TH ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681541515",
"telephone_number": "402-991-3131"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PROVISION EYE CARE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2016-06-14",
"last_updated": "2016-07-06",
"status": "A",
"authorized_official_last_name": "JACKSON",
"authorized_official_first_name": "DANIEL",
"authorized_official_middle_name": "MARK",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "402-991-3131",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "O.D."
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "NE",
"license": "960",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00393695",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10025388400",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SHARE ADVANTAGE",
"identifier": "904415",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "37154",
"state": "NE"
}
],
"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 Jul 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.