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General NPI Number Information
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NPI Number | 1205015963
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Entity Type | Organization
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Legal Business Name | JERRY G DAMME O.D.,P.C.
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 10/30/2007
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Provider Practice Location Address
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Address Line | 504 N WASHINGTON ST BOX 461066
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City | PAPILLION
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State | NE
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Zip | 68046-2236
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Country | US
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Telephone | 402-592-4980
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Fax |
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Provider Business Mailing Address
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Address Line | 504 N WASHINGTON ST BOX 461066
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City | PAPILLION
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State | NE
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Zip | 68046-2236
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Country | US
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Telephone | 402-592-4980
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JERRY G DAMME
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Credential | OD
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Telephone | 402-592-4980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 816
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License Number State | NE
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