=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518272798
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE D DUFNER O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2010
-----------------------------------------------------
Last Update Date | 01/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8650 S 71ST PLZ SUITE D
-----------------------------------------------------
City | PAPILLION
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68133-2104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-408-1016
-----------------------------------------------------
Fax | 402-408-1017
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8650 S 71ST PLZ SUITE D
-----------------------------------------------------
City | PAPILLION
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68133-2104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-408-1016
-----------------------------------------------------
Fax | 402-408-1017
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1349
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------