Healthcare Provider Details

I. General information

NPI: 1790774347
Provider Name (Legal Business Name): JEREMY W MCMEEN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 N CENTRAL
SUPERIOR NE
68978-1715
US

IV. Provider business mailing address

358 N CENTRAL
SUPERIOR NE
68978-1715
US

V. Phone/Fax

Practice location:
  • Phone: 402-879-3233
  • Fax: 402-879-3378
Mailing address:
  • Phone: 402-879-3233
  • Fax: 402-879-3378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1093
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1489
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: