Provider Demographics
NPI:1154308583
Name:SAUM, JEFFREY S (OD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:SAUM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:NE
Mailing Address - Zip Code:68638-3126
Mailing Address - Country:US
Mailing Address - Phone:308-536-2268
Mailing Address - Fax:308-536-2329
Practice Address - Street 1:220 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:NE
Practice Address - Zip Code:68638-3126
Practice Address - Country:US
Practice Address - Phone:308-536-2268
Practice Address - Fax:308-536-2329
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1037152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47082635801Medicaid
NE36767OtherBLUE CROSS BLUE SHIELD
NE272348Medicare ID - Type Unspecified
NE47082635801Medicaid