Provider Demographics
NPI:1720193246
Name:JASON WEBB OD PC
Entity Type:Organization
Organization Name:JASON WEBB OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:308-635-0800
Mailing Address - Street 1:820 W 42ND ST STE 1200
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4704
Mailing Address - Country:US
Mailing Address - Phone:308-635-0800
Mailing Address - Fax:308-635-0899
Practice Address - Street 1:820 W 42ND ST STE 1200
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4704
Practice Address - Country:US
Practice Address - Phone:308-635-0800
Practice Address - Fax:308-635-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1156152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025345400Medicaid
NEU82008Medicare UPIN
NE900021Medicare PIN