Vance Thompson Vision Surgery Center NE, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

VANCE THOMPSON VISION SURGERY CENTER NE, LLC

Practice address

4909 S 118TH St
Omaha, NE 68137-2213

Phone

(402) 506-9970

Fax

(605) 371-7199

NPI assigned

Dec 12, 2019

Last updated

Jun 19, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John Palmer Berdahl, MDNPI 1871761577

Title

Owner

Phone

(605) 361-3937

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NE

Enrollment records 1

Listed as

Vance Thompson Vision Surgery Center NE LLCCCN 28C0001037

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John Palmer Berdahl, M.D.

  • Ophthalmology Physician
  • Sioux Falls, SD
  • NPI 1871761577
  Authorized official Same address or phone
• Brandon James Baartman, M.D.

  • Ophthalmology Physician
  • Omaha, NE
  • NPI 1124464664
  NPD (past)
• Keegan Brady Mechels

  • Ophthalmology Physician
  • Omaha, NE
  • NPI 1821558420
  NPD (past)
• Lorraine Myers Provencher, M.D.

  • Ophthalmology Physician
  • Omaha, NE
  • NPI 1174935910
  NPD (past)
• Deborah Gess Ristvedt, D.O.

  • Ophthalmology Physician
  • Alexandria, MN
  • NPI 1871881656
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1576108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687132800000",
    "number": "1992343610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3101 W 57TH ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571083162",
            "telephone_number": "605-361-3937",
            "fax_number": "605-371-7199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4909 S 118TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681372213",
            "telephone_number": "402-506-9970",
            "fax_number": "605-371-7199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANCE THOMPSON VISION SURGERY CENTER NE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-12",
        "last_updated": "2023-06-19",
        "certification_date": "2023-06-19",
        "status": "A",
        "authorized_official_last_name": "BERDAHL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "PALMER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "605-361-3937",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trinity Vanausdal
• Megan Elizabeth Vanbencoten, LIMHP
• Lilyauna Vanbibber
• Alyx Vanblaricon Lutes, COTA/L
• Vance Thompson Vision NE, Prof LLC
• Dylan Vance, MD
• Laura Marie Vance, D.O.
• Malia Vance
• Michael D Vance, PHD
• Rebekah Vance

• Ambulatory Surgical Clinic/Center in Omaha, NE
• Providers in Omaha, NE by specialty
• Ambulatory Surgical Clinic/Center in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.