Provider Demographics
NPI:1326346339
Name:STATTON, STEPHEN A (ABOC)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:A
Last Name:STATTON
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4645 NORMAL BLVD
Mailing Address - Street 2:SUITE 132
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5588
Mailing Address - Country:US
Mailing Address - Phone:402-486-4828
Mailing Address - Fax:402-486-4828
Practice Address - Street 1:4645 NORMAL BLVD
Practice Address - Street 2:SUITE 132
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516
Practice Address - Country:US
Practice Address - Phone:402-486-4828
Practice Address - Fax:402-486-4828
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
081991OtherABOC
NE6549480001Medicare NSC