Healthcare Provider Details

I. General information

NPI: 1598816555
Provider Name (Legal Business Name): OCULI VISION REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 INFINITY RD STE B
LINCOLN NE
68512-3713
US

IV. Provider business mailing address

1401 INFINITY RD STE B
LINCOLN NE
68512-3713
US

V. Phone/Fax

Practice location:
  • Phone: 402-420-1177
  • Fax: 402-420-1176
Mailing address:
  • Phone: 402-420-1177
  • Fax: 402-420-1176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number2008026019
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225XL0004X
TaxonomyLow Vision Occupational Therapist
License Number2008004614
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number2007023592
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2007023592
License Number StateMO

VIII. Authorized Official

Name: DR. JAMES L. NEDROW
Title or Position: CHAIRMAN OF THE BOARD & MANAGING PR
Credential: O.D. (OPTOMETRIST)
Phone: 402-420-1177