Healthcare Provider Details

I. General information

NPI: 1154424307
Provider Name (Legal Business Name): OMAHA EYE & LASER INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11606 NICHOLAS ST SUITE 200
OMAHA NE
68154-4478
US

IV. Provider business mailing address

11606 NICHOLAS ST SUITE 200
OMAHA NE
68154-4478
US

V. Phone/Fax

Practice location:
  • Phone: 402-493-2020
  • Fax: 402-493-8341
Mailing address:
  • Phone: 402-493-2020
  • Fax: 402-493-8341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SAO JANG LIU
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 402-493-2020