Provider Demographics
NPI:1598816555
Name:OCULI VISION REHABILITATION, LLC
Entity Type:Organization
Organization Name:OCULI VISION REHABILITATION, LLC
Other - Org Name:VISION RECOVERY OF AMERICA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD & MANAGING PR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEDROW
Authorized Official - Suffix:
Authorized Official - Credentials:OD (OPTOMETRIST)
Authorized Official - Phone:402-420-1177
Mailing Address - Street 1:1401 INFINITY RD STE B
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-3713
Mailing Address - Country:US
Mailing Address - Phone:402-420-1177
Mailing Address - Fax:402-420-1176
Practice Address - Street 1:1401 INFINITY RD STE B
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-3713
Practice Address - Country:US
Practice Address - Phone:402-420-1177
Practice Address - Fax:402-420-1176
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OCULI VISION REHABILITATION, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-16
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007023592152W00000X, 152WL0500X
MO2008026019152WL0500X
MO2008004614225XL0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
No225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow VisionGroup - Multi-Specialty