Provider Demographics
NPI:1154424307
Name:OMAHA EYE & LASER INSTITUTE, INC.
Entity type:Organization
Organization Name:OMAHA EYE & LASER INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAO
Authorized Official - Middle Name:JANG
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-493-2020
Mailing Address - Street 1:11606 NICHOLAS ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4478
Mailing Address - Country:US
Mailing Address - Phone:402-493-2020
Mailing Address - Fax:402-493-8341
Practice Address - Street 1:11606 NICHOLAS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4478
Practice Address - Country:US
Practice Address - Phone:402-493-2020
Practice Address - Fax:402-493-8341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA1228Medicare PIN
NE099044Medicare PIN
IAI3130Medicare PIN