Provider Demographics
NPI:1033097977
Name:DANNAR, JERAMY (ABOC NCLE)
Entity type:Individual
Prefix:
First Name:JERAMY
Middle Name:
Last Name:DANNAR
Suffix:
Gender:M
Credentials:ABOC NCLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 W PASEWALK AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4608
Mailing Address - Country:US
Mailing Address - Phone:402-371-5715
Mailing Address - Fax:402-371-6152
Practice Address - Street 1:2400 W PASEWALK AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4608
Practice Address - Country:US
Practice Address - Phone:402-371-5715
Practice Address - Fax:402-371-6152
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
266750156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician