Provider Demographics
NPI:1538420765
Name:BURKEY, JEDIDIAH MICHAEL (OD)
Entity type:Individual
Prefix:
First Name:JEDIDIAH
Middle Name:MICHAEL
Last Name:BURKEY
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 1:3010 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2479
Mailing Address - Country:US
Mailing Address - Phone:402-727-0804
Mailing Address - Fax:402-727-6102
Practice Address - Street 1:3010 E 23RD ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2479
Practice Address - Country:US
Practice Address - Phone:402-727-0804
Practice Address - Fax:402-727-6102
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1414152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist