1427746403 NPI number — SALUTE VISION CARE

Table of content: (NPI 1427746403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427746403 NPI number — SALUTE VISION CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SALUTE VISION CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427746403
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3105 SHERIDAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68123-5320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-452-7854
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 MEYER AVE BLDG 166
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OFFUTT AFB
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68113-2000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-292-0396
Provider Business Practice Location Address Fax Number:
402-292-2263
Provider Enumeration Date:
04/27/2023

Additional Information

Authorized Official

Authorized Official Last Name:
FREEMAN
Authorized Official First Name:
VIVIANLE
Authorized Official Middle Name:
BENSON
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
402-452-7854

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1366439010 . This is a "VIVIANLE FREEMAN" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 1427746403 . This is a "NPI2" identifier . This identifiers is of the category "OTHER".




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