Grand Island Optical PC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

GRAND ISLAND OPTICAL PC

Doing business as

Aurora Eyecare Professionals

Practice address

1208 L St
Aurora, NE 68818-2016

Phone

(402) 694-6114

NPI assigned

Jun 4, 2010

Last updated

Oct 7, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Rene Dawn Ketteler

Title

Business Manager

Phone

(308) 384-0220

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Aurora Eyecare Professionals Doing business as

Medicare fee-for-service enrollment

Enrolled in NE2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Grand Island Optical PC

  dba Eyecare Professionals

  • Eyewear Supplier
  • Grand Island, NE
  • NPI 1891771051

  5799752150

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Grand Island Optical PC

  dba Eyecare Professionals

  • Eyewear Supplier
  • Grand Island, NE
  • NPI 1891771051

  O20040914001318

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 1

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.

• Roger G Holling, O.D.

  • Optometrist
  • Aurora, NE
  • NPI 1255442646
  NPD (past)

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

{
    "created_epoch": "1275609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286409600000",
    "number": "1942520614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 128",
            "city": "AURORA",
            "state": "NE",
            "postal_code": "688180128",
            "telephone_number": "402-694-6114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1208 L ST",
            "city": "AURORA",
            "state": "NE",
            "postal_code": "688182016",
            "telephone_number": "402-694-6114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND ISLAND OPTICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-04",
        "last_updated": "2010-10-07",
        "status": "A",
        "authorized_official_last_name": "KETTELER",
        "authorized_official_first_name": "RENE",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "308-384-0220"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025853800",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aurora Eyecare Professionals",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Billinda Kay Elliott
• Alexis R. Erbst, M.D.
• Esslinger Physical Therapy LLC
• Philip Esslinger
• Andrew Farrand
• Griess Chiropractic and Wellness Center, P.C.
• Lukas Eugene Griess, D.C.
• Faith A Gustafson
• Hamilton County
• Hamilton County Home for the Aged (Hamilton Manor)

• Optometrist in Aurora, NE
• Providers in Aurora, NE by specialty
• Optometrist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.