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General NPI Number Information
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NPI Number | 1679921720
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Entity Type | Organization
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Legal Business Name | STATTON OPTICAL
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Dates
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Enumeration Date | 05/31/2016
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Last Update Date | 05/31/2016
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Provider Practice Location Address
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Address Line | 4645 NORMAL BLVD STE 132
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City | LINCOLN
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State | NE
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Zip | 68506-5823
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Country | US
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Telephone | 402-486-4828
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Fax |
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Provider Business Mailing Address
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Address Line | 4645 NORMAL BLVD STE 132
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City | LINCOLN
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State | NE
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Zip | 68506-5823
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Country | US
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Telephone | 402-486-4828
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Fax |
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Authorized Official
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Title or Position | OPTICIAN
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Name | MR. STEPHEN A STATTON
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Credential | ABOC
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Telephone | 402-486-4828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | ABOC 081991
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License Number State | NE
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