Provider Demographics
NPI:1790774347
Name:MCMEEN, JEREMY W (OD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:W
Last Name:MCMEEN
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 1:358 N CENTRAL
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:NE
Mailing Address - Zip Code:68978-1715
Mailing Address - Country:US
Mailing Address - Phone:402-879-3233
Mailing Address - Fax:402-879-3378
Practice Address - Street 1:358 N CENTRAL
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:NE
Practice Address - Zip Code:68978-1715
Practice Address - Country:US
Practice Address - Phone:402-879-3233
Practice Address - Fax:402-879-3378
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1093152W00000X
KS1489152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100263170AMedicaid
NE36742OtherBCBS NEBRASKA
NE410033190OtherRAILROAD MEDICARE
NE47080270700Medicaid
KS49839OtherBCBS KANSAS
KS100263170AMedicaid
NE1144440001OtherCIGNA/DMERC
KS100263170AMedicaid