Provider Demographics
NPI:1447254982
Name:GLEASON-JANKY EYE PHYSICIANS PC
Entity type:Organization
Organization Name:GLEASON-JANKY EYE PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GLEASON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:308-381-4733
Mailing Address - Street 1:611 N DIERS AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4960
Mailing Address - Country:US
Mailing Address - Phone:308-381-4733
Mailing Address - Fax:308-381-6462
Practice Address - Street 1:611 N DIERS AVE
Practice Address - Street 2:STE 2
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4960
Practice Address - Country:US
Practice Address - Phone:308-381-4733
Practice Address - Fax:308-381-6462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19617207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
NE=========13Medicaid