Provider Demographics
NPI:1215231717
Name:DEFINITIVE VISION LLC
Entity Type:Organization
Organization Name:DEFINITIVE VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:ELWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-502-7323
Mailing Address - Street 1:3157 FARNAM ST STE 7105
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-3553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3157 FARNAM ST
Practice Address - Street 2:SUITE 7103
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-3553
Practice Address - Country:US
Practice Address - Phone:402-203-8885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1201152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty