Provider Demographics
NPI:1205015963
Name:JERRY G DAMME O.D.,P.C.
Entity Type:Organization
Organization Name:JERRY G DAMME O.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:DAMME
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-592-4980
Mailing Address - Street 1:504 N WASHINGTON ST
Mailing Address - Street 2:BOX 461066
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-2236
Mailing Address - Country:US
Mailing Address - Phone:402-592-4980
Mailing Address - Fax:
Practice Address - Street 1:504 N WASHINGTON ST
Practice Address - Street 2:BOX 461066
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-2236
Practice Address - Country:US
Practice Address - Phone:402-592-4980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE816332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier