MEDICARE: UNIVERSITY OF NEBRASKA BOARD OF REGENTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OP0298	OTHER	NE	EYEMED INSURANCE

General Provider Information

NPI Number	:	1316979628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF NEBRASKA BOARD OF REGENTS

Provider Business Mailing Address
First Line	:	985540 NEBRASKA MEDICAL CTR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68198-5540
Country	:	US
Telephone Number	:	402-559-8351
Fax Number	:	402-559-3993

Provider Business Practice Location Address
First Line	:	3902 LEAVENWORTH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68105-1119
Country	:	US
Telephone Number	:	402-559-8351
Fax Number	:	402-559-3993

Authorized Official
Title or Position	:	ASSOCIATE VICE CHANCELLOR
Name	:	DEBORAH L THOMAS
Credential	:	MPA
Telephone Number	:	402-559-5200

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/11/2013

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