Healthcare Provider Details

I. General information

NPI: 1326346339
Provider Name (Legal Business Name): STEPHEN A STATTON ABOC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 NORMAL BLVD SUITE 132
LINCOLN NE
68516
US

IV. Provider business mailing address

4645 NORMAL BLVD SUITE 132
LINCOLN NE
68506-5588
US

V. Phone/Fax

Practice location:
  • Phone: 402-486-4828
  • Fax: 402-486-4828
Mailing address:
  • Phone: 402-486-4828
  • Fax: 402-486-4828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: