Provider Demographics
NPI:1609447986
Name:WIETFELD, EMILY JOANN (OD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JOANN
Last Name:WIETFELD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W DECATUR ST
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:NE
Mailing Address - Zip Code:68788-1407
Mailing Address - Country:US
Mailing Address - Phone:402-317-0995
Mailing Address - Fax:
Practice Address - Street 1:101 W DECATUR ST
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:NE
Practice Address - Zip Code:68788-1407
Practice Address - Country:US
Practice Address - Phone:402-317-0995
Practice Address - Fax:402-372-5736
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1541152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist