Provider Demographics
NPI:1538150115
Name:SANGER, JEFFREY W (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:W
Last Name:SANGER
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:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:NE
Mailing Address - Zip Code:68822-0506
Mailing Address - Country:US
Mailing Address - Phone:308-872-2291
Mailing Address - Fax:308-872-3122
Practice Address - Street 1:408 S 8TH AVE
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:NE
Practice Address - Zip Code:68822-2009
Practice Address - Country:US
Practice Address - Phone:308-872-2291
Practice Address - Fax:308-872-3122
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1015152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47077269013Medicaid
NEP00603623OtherRR MEDICARE
NE6719OtherBLUE CROSS BLUE SHIELD NE
NESSN00Medicaid
NE36012OtherMIDLANDS
NE410018187OtherRAILROAD INDIV PROVIDER #
NE37064OtherBCBS OF NE
NESSN00Medicaid
NE36012OtherMIDLANDS
NEU23600Medicare UPIN