Provider Demographics
NPI:1225169782
Name:LINCOLN VISION CENTER, PC
Entity Type:Organization
Organization Name:LINCOLN VISION CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:EDIGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-466-1916
Mailing Address - Street 1:651 N 66TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2478
Mailing Address - Country:US
Mailing Address - Phone:402-466-1916
Mailing Address - Fax:402-466-4154
Practice Address - Street 1:651 N 66TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2478
Practice Address - Country:US
Practice Address - Phone:402-466-1916
Practice Address - Fax:402-466-4154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE766152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE099048Medicare UPIN
NE=========00Medicaid