Provider Demographics
NPI:1932166428
Name:OCONNOR, JEFFREY T (OD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:T
Last Name:OCONNOR
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 1:111 S BAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5404
Mailing Address - Country:US
Mailing Address - Phone:308-534-2000
Mailing Address - Fax:308-534-2001
Practice Address - Street 1:111 S BAILEY AVE
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5404
Practice Address - Country:US
Practice Address - Phone:308-534-2000
Practice Address - Fax:308-534-2001
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE964152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE6917OtherBCBS
NE47054418213Medicaid
NE6917OtherBCBS
NE096729Medicare PIN