Healthcare Provider Details

I. General information

NPI: 1477890937
Provider Name (Legal Business Name): ILUMIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 REGENCY PKWY SUITE 110
OMAHA NE
68114-3764
US

IV. Provider business mailing address

16820 FRANCES ST SUITE 100
OMAHA NE
68130-2391
US

V. Phone/Fax

Practice location:
  • Phone: 402-933-6600
  • Fax: 402-933-7123
Mailing address:
  • Phone: 402-933-6600
  • Fax: 402-933-7127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: SHERRY THORAU
Title or Position: ADMINISTRATOR
Credential:
Phone: 402-933-6600