Provider Demographics
NPI:1144475740
Name:SUPERIOR VISION PC
Entity type:Organization
Organization Name:SUPERIOR VISION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCMEEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-879-3233
Mailing Address - Street 1:358 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:NE
Mailing Address - Zip Code:68978
Mailing Address - Country:US
Mailing Address - Phone:402-879-3233
Mailing Address - Fax:402-879-3378
Practice Address - Street 1:358 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:NE
Practice Address - Zip Code:68978
Practice Address - Country:US
Practice Address - Phone:402-879-3233
Practice Address - Fax:402-879-3378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1093332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100263170AMedicaid
NE410033190OtherPALMETTO RAILROAD MEDICARE
KS49839OtherBCBS KANSAS
NE36742OtherBCBS NEBRASKA
NE36742OtherBCBS NEBRASKA
KS100263170AMedicaid