Organization
PRAIRIE EYECARE CENTER LLC
Active
Parent organization
PRAIRIE EYECARE CENTER PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PRAIRIE EYECARE CENTER PC
Authorized official
DR. JEFFFREY W SANGER OD (OWNER)
(308) 872-2291
Entity
Organization
Contact information
Practice address
408 S 8TH AVE, BROKEN BOW, NE 68822-2009
(308) 872-2291
(308) 872-3122
Mailing address
408 S 8TH AVE, BROKEN BOW, NE 68822-2009
(308) 872-2291
(308) 872-3122
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0723900001
DMERC
—
01
—
098011
MEDICARE PTAN
—
01
—
410011100
RR MEDICARE
—
Enumeration date
10/07/2008
Last updated
10/07/2008
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