Provider Demographics
NPI:1316133556
Name:BELLEVUE FAMILY EYECARE CENTER PC
Entity type:Organization
Organization Name:BELLEVUE FAMILY EYECARE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:LEMPP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-964-2700
Mailing Address - Street 1:11513 S 42 ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-6006
Mailing Address - Country:US
Mailing Address - Phone:402-964-2700
Mailing Address - Fax:
Practice Address - Street 1:11513 S 42 ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-6006
Practice Address - Country:US
Practice Address - Phone:402-964-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1225152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099749Medicare PIN