Provider Demographics
NPI:1871757492
Name:DEVRIES, AMY JENNIFER (OD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:JENNIFER
Last Name:DEVRIES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:JENNIFER
Other - Last Name:SPARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2955 E ELK LANE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-8814
Mailing Address - Country:US
Mailing Address - Phone:402-721-8032
Mailing Address - Fax:402-721-2874
Practice Address - Street 1:2955 E ELK LANE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-8814
Practice Address - Country:US
Practice Address - Phone:402-721-8032
Practice Address - Fax:402-721-2474
Is Sole Proprietor?:No
Enumeration Date:2008-07-13
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002428152W00000X
NE1358152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470676989-13Medicaid
NE098163001Medicare PIN