Provider Demographics
NPI:1407042153
Name:BELLEVUE VISION CLINIC, PC
Entity Type:Organization
Organization Name:BELLEVUE VISION CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:PILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-291-6133
Mailing Address - Street 1:1810 WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-3680
Mailing Address - Country:US
Mailing Address - Phone:402-291-6133
Mailing Address - Fax:
Practice Address - Street 1:1810 WILSHIRE DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-3680
Practice Address - Country:US
Practice Address - Phone:402-291-6133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE095152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE093870Medicare PIN