Provider Demographics
NPI:1518048198
Name:DAMME, JERRY G (OD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:G
Last Name:DAMME
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 1:4353 DODGE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2709
Mailing Address - Country:US
Mailing Address - Phone:402-552-2020
Mailing Address - Fax:402-552-2367
Practice Address - Street 1:7202 GILES RD
Practice Address - Street 2:SUITE 3
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-6000
Practice Address - Country:US
Practice Address - Phone:402-552-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE816152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0659240001OtherDEMERC
410014479OtherRAILROAD RETIREMENT
NE47-062372200Medicaid
094431Medicare ID - Type Unspecified
T40293Medicare UPIN