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NPI Code Detail

MEDICARE: DR. JENNIFER RAELYN DEETS O.D.

MEDICARE: DR. JENNIFER RAELYN DEETS 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
1152W00000XOptometrist1369NE

Other Identifiers

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

General Provider Information

NPI Number : 1528384047
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JENNIFER RAELYN DEETS O.D.
Provider Business Mailing Address
First Line : 2303 OSBORNE DR W
Second Line :
City : HASTINGS
State : NE
Zip : 68901-9116
Country : US
Telephone Number : 402-834-2222
Fax Number : 402-834-3214
Provider Business Practice Location Address
First Line : 2303 OSBORNE DR W
Second Line :
City : HASTINGS
State : NE
Zip : 68901-9116
Country : US
Telephone Number : 402-834-2222
Fax Number : 402-834-3214
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2010
Last Update Date : 09/07/2021

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