Prairie Eyecare Center PC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

PRAIRIE EYECARE CENTER PC

Practice address

408 S 8TH Ave
Broken Bow, NE 68822-2009

Phone

(308) 872-2291

Fax

(308) 872-3122

NPI assigned

Nov 2, 2005

Organization subpart

No

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

Authorized official

Name

Dr. Jeffrey W Sanger, O.D.NPI 1538150115

Title

Owner

Phone

(308) 872-2291

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Prairie Eyecare Center LLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in NE

Enrollment records 1

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.

• Prairie Eyecare Center LLC

  • Optometrist
  • Broken Bow, NE
  • NPI 1295986370
  NPPES parent name

Practitioners 3

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

• Jeffrey W Sanger, O.D.

  • Optometrist
  • Broken Bow, NE
  • NPI 1538150115
  Medicare reassignment Care Compare group Authorized official
• Jincy Anna Ross, OD

  • Optometrist
  • Broken Bow, NE
  • NPI 1932877685
  Medicare reassignment Care Compare group NPD
• Donald R Krysl, OD

  • Optometrist
  • La Vista, NE
  • NPI 1730118233
  NPD (past)

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217894400000",
    "number": "1932190527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 506",
            "address_2": "408 S 8TH AVE",
            "city": "BROKEN BOW",
            "state": "NE",
            "postal_code": "688220506",
            "telephone_number": "308-872-2291",
            "fax_number": "308-872-3122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 S 8TH AVE",
            "city": "BROKEN BOW",
            "state": "NE",
            "postal_code": "688222009",
            "telephone_number": "308-872-2291",
            "fax_number": "308-872-3122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE EYECARE CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-02",
        "last_updated": "2008-08-05",
        "status": "A",
        "authorized_official_last_name": "SANGER",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "308-872-2291",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47077269013",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA RAILROAD MED",
            "identifier": "C04190",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PTAN",
            "identifier": "DN0887",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025628100",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prairie Eyecare Center LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Deniece P Petersen, DPT
• Justin Petersen
• Rachel Peterson, RDH
• Louella Delvon Porter
• Prairie Eyecare Center LLC
• Prairie Pioneer Center
• Quality Senior Villages
• Carol Reichenbeg
• Angela Marie Renner, DPT
• Lori Reynolds

• Optometrist in Broken Bow, NE
• Providers in Broken Bow, NE by specialty
• Optometrist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2008; 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.