Provider Demographics
NPI:1588043616
Name:WILLS, DEREK JASON (OD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:JASON
Last Name:WILLS
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 1:4925 COPPER HILL DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68157-2920
Mailing Address - Country:US
Mailing Address - Phone:402-305-4494
Mailing Address - Fax:
Practice Address - Street 1:7474 TOWNE CENTER PKWY
Practice Address - Street 2:STE 107
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4805
Practice Address - Country:US
Practice Address - Phone:402-592-3266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1436152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist