Provider Demographics
NPI:1710944483
Name:WEBB, JASON A (OD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:A
Last Name:WEBB
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 1:313 W 38TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4770
Mailing Address - Country:US
Mailing Address - Phone:308-635-0800
Mailing Address - Fax:
Practice Address - Street 1:313 W 38TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4687
Practice Address - Country:US
Practice Address - Phone:308-635-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1156152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025345400Medicaid
NE272976Medicare PIN
U82008Medicare UPIN