# OREGON TRAIL EYE SURGERY CENTER, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003909789
- **Authorized official:** BARBARA J. MIDDLE (ADMINISTRATOR)
- **Authorized official phone:** (308) 635-3911

## Contact information

- **Practice address:** 329 WEST 40TH STREET, SCOTTSBLUFF, NE 69361-4634
- **Practice address phone:** (308) 635-3911
- **Practice address fax:** (308) 635-3130
- **Mailing address:** 329 WEST 40TH STREET, SCOTTSBLUFF, NE 69361-4634
- **Mailing address phone:** (308) 635-3911
- **Mailing address fax:** (308) 635-3130

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | ASC039 | NE | Yes |

## Other

- **Enumeration date:** 10/02/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 10025073600 | — | NE |
| 05 | — | 5490380 | — | NE |