Organization
ILLUSIONS EYEWEAR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TOMMIE LEE BLAN JR. (OPTICIAN OWNER)
(402) 451-1717
Entity
Organization
Contact information
Practice address
8616 N 30TH ST, OMAHA, NE 68112-1808
(402) 451-1717
(402) 451-3469
Mailing address
8616 N 30TH ST, OMAHA, NE 68112-1808
(402) 451-1717
(402) 451-3469
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017542
—
NE
05
—
10025369100
—
NE
01
—
NA1057
PTAN
—
Enumeration date
03/13/2007
Last updated
06/11/2008
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