Provider Demographics
NPI:1124562699
Name:NEBRASKA VISUAL INTEGRATION CENTER
Entity Type:Organization
Organization Name:NEBRASKA VISUAL INTEGRATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TANNER
Authorized Official - Middle Name:CALVIN
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-502-0043
Mailing Address - Street 1:11905 P ST
Mailing Address - Street 2:STE. #106
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2237
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11905 P ST
Practice Address - Street 2:STE. #106
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2237
Practice Address - Country:US
Practice Address - Phone:402-502-0043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-18
Last Update Date:2016-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1362152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty