Organization
SIDNEY VISION CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY ALAN COOK O.D. (PARTNER)
(308) 254-4041
Entity
Organization
Contact information
Practice address
900 PINE ST, SIDNEY, NE 69162-2241
(308) 254-4041
(308) 254-3718
Mailing address
PO BOX 61, SIDNEY, NE 69162-0061
(308) 254-4041
(308) 254-3718
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
892
NE
152WC0802X
Corneal and Contact Management Optometrist
892
NE
152WP0200X
Pediatric Optometrist
892
NE
152WS0006X
Sports Vision Optometrist
892
NE
152WV0400X
Vision Therapy Optometrist
892
NE
152WX0102X
Occupational Vision Optometrist
892
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025341000
—
NE
01
—
245327
MIDLANDS CHOICE PROV NMBR
NE
01
—
37094
BCBS PROVIDER NUMBER
NE
01
—
410025992
UHC RR MEDICARE PROVIDER
NE
Enumeration date
04/17/2007
Last updated
02/19/2020
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