Provider Demographics
NPI:1164709218
Name:AMY J. DEVRIES, O.D., P.C.
Entity Type:Organization
Organization Name:AMY J. DEVRIES, O.D., P.C.
Other - Org Name:FREMONT VISION SOURCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:JENNIFER
Authorized Official - Last Name:DEVRIES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-721-8032
Mailing Address - Street 1:2955 E ELK LANE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-8814
Mailing Address - Country:US
Mailing Address - Phone:402-721-8032
Mailing Address - Fax:402-721-2874
Practice Address - Street 1:2955 E ELK LANE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-8814
Practice Address - Country:US
Practice Address - Phone:402-721-8032
Practice Address - Fax:402-721-2874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1358152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty