Provider Demographics
NPI:1326113408
Name:DOROTHY J SETLAK
Entity Type:Organization
Organization Name:DOROTHY J SETLAK
Other - Org Name:TUFLYS SHOE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:TUFLY
Authorized Official - Suffix:
Authorized Official - Credentials:C PED
Authorized Official - Phone:402-614-2221
Mailing Address - Street 1:16909 LAKESIDE HILLS PLZ
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-4654
Mailing Address - Country:US
Mailing Address - Phone:402-614-2221
Mailing Address - Fax:402-505-3100
Practice Address - Street 1:16909 LAKESIDE HILLS PLZ
Practice Address - Street 2:SUITE 102
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-4654
Practice Address - Country:US
Practice Address - Phone:402-614-2221
Practice Address - Fax:402-505-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0998856Medicaid
NE=========00Medicaid
NE=========OtherTRICARE
IA0998856Medicaid