Provider Demographics
NPI:1124172390
Name:TKC OPTICAL, INC
Entity type:Organization
Organization Name:TKC OPTICAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-252-1519
Mailing Address - Street 1:229 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1401
Mailing Address - Country:US
Mailing Address - Phone:712-252-1519
Mailing Address - Fax:712-252-1916
Practice Address - Street 1:4919 2ND AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-2482
Practice Address - Country:US
Practice Address - Phone:308-237-7693
Practice Address - Fax:308-237-2948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE01-8514550332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE36375OtherBCBS
68239D009OtherHEALTH PLAN SERVICE
21516OtherSPECTERA
121510OtherEYEMED
231718OtherMIDLANDS CHOICE
68239D009OtherHEALTH PLAN SERVICE
121510OtherEYEMED
NE4224440003Medicare ID - Type Unspecified