Provider Demographics
NPI:1487613550
Name:DOB, NANCY ANN (OD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:DOB
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-2946
Mailing Address - Country:US
Mailing Address - Phone:402-362-3313
Mailing Address - Fax:402-362-1533
Practice Address - Street 1:625 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-2946
Practice Address - Country:US
Practice Address - Phone:402-362-3313
Practice Address - Fax:402-362-1533
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE931152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47070972613Medicaid
268404Medicare PIN
NE47070972613Medicaid