Provider Demographics
NPI:1699124958
Name:MODERNEYES EYECARE & EYEWEAR, PC
Entity type:Organization
Organization Name:MODERNEYES EYECARE & EYEWEAR, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:OD, FAAO
Authorized Official - Phone:402-807-3937
Mailing Address - Street 1:19060 Q ST STE 107
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-1504
Mailing Address - Country:US
Mailing Address - Phone:402-807-3937
Mailing Address - Fax:
Practice Address - Street 1:19060 Q ST
Practice Address - Street 2:SUITE 107
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-1503
Practice Address - Country:US
Practice Address - Phone:402-616-6319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1398152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty