Provider Demographics
NPI:1699852756
Name:FAMILY VISION CENTER, PC
Entity Type:Organization
Organization Name:FAMILY VISION CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAURITZEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-625-5081
Mailing Address - Street 1:221 N OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68045-1338
Mailing Address - Country:US
Mailing Address - Phone:402-685-5081
Mailing Address - Fax:
Practice Address - Street 1:221 N OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NE
Practice Address - Zip Code:68045-1338
Practice Address - Country:US
Practice Address - Phone:402-685-5081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE767152W00000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE8422OtherOAKLAND MIDLANDS CHOICE
NE7748OtherOAKLAND BLUE CROSS
NE25136OtherOAKLAND CONVENTRY PAYOR
NE7748OtherOAKLAND BLUE CROSS
NE7748OtherOAKLAND BLUE CROSS
NE8422OtherOAKLAND MIDLANDS CHOICE
NE098423Medicare PIN