Provider Demographics
NPI:1902994874
Name:MCIVER, DUSTY LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:DUSTY
Middle Name:LEE
Last Name:MCIVER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:17838 BURKE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-2256
Mailing Address - Country:US
Mailing Address - Phone:402-558-2211
Mailing Address - Fax:402-558-2212
Practice Address - Street 1:17838 BURKE ST STE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-2256
Practice Address - Country:US
Practice Address - Phone:402-558-2211
Practice Address - Fax:402-558-2212
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1479152W00000X
AR2580152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR49965Medicare PIN
ARV11140Medicare UPIN