Provider Demographics
NPI:1275665762
Name:DEVELOPMENTAL VISION ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:DEVELOPMENTAL VISION ASSOCIATES, P.C.
Other - Org Name:DEVELOPMENTAL VISION ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:VANDERVORT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-493-6500
Mailing Address - Street 1:9900 NICHOLAS ST
Mailing Address - Street 2:SUITE 275
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2149
Mailing Address - Country:US
Mailing Address - Phone:402-493-6500
Mailing Address - Fax:402-493-4370
Practice Address - Street 1:9900 NICHOLAS ST
Practice Address - Street 2:SUITE 275
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2149
Practice Address - Country:US
Practice Address - Phone:402-493-6500
Practice Address - Fax:402-493-4370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE927152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty