MEDICARE: DR. JANET ROSE FETT O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	957	NE
2	152W00000X	Optometrist	915	IA
3	152W00000X	Optometrist	522	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0392900001	OTHER		DMERC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457374563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANET ROSE FETT O.D.

Provider Business Mailing Address
First Line	:	1000 W 29TH ST
Second Line	:	SUITE 302
City	:	SOUTH SIOUX CITY
State	:	NE
Zip	:	68776-3153
Country	:	US
Telephone Number	:	402-494-5533
Fax Number	:	402-494-5534

Provider Business Practice Location Address
First Line	:	1000 W 29TH ST
Second Line	:	SUITE 302
City	:	SOUTH SIOUX CITY
State	:	NE
Zip	:	68776-3153
Country	:	US
Telephone Number	:	402-494-5533
Fax Number	:	402-494-5534

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	11/20/2007

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