Provider Demographics
NPI:1265437750
Name:DARNELL, JON M (OD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:M
Last Name:DARNELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:416 VALLEY VIEW DR # 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-1486
Mailing Address - Country:US
Mailing Address - Phone:308-635-1633
Mailing Address - Fax:308-635-2880
Practice Address - Street 1:416 VALLEY VIEW DR # 100
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-1486
Practice Address - Country:US
Practice Address - Phone:308-635-1633
Practice Address - Fax:308-635-2880
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1223152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1265437750OtherDR. DARNELL NPI
1710903984OtherGROUP NPI
NE$$$$$$$$$Medicaid
093988Medicare PIN
CQ4076Medicare PIN
1710903984OtherGROUP NPI
NE$$$$$$$$$Medicaid