Healthcare Provider Details

I. General information

NPI: 1205250602
Provider Name (Legal Business Name): JEPSEN OPTOMETRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6304 N 99TH ST
OMAHA NE
68134-1528
US

IV. Provider business mailing address

6304 N 99TH ST
OMAHA NE
68134-1528
US

V. Phone/Fax

Practice location:
  • Phone: 402-492-9440
  • Fax:
Mailing address:
  • Phone: 402-492-9440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. MURIEL JEPSEN
Title or Position: OWNER
Credential: O.D.
Phone: 402-290-1151