Provider Demographics
NPI:1679575864
Name:MEYERS, STEPHANIE JEANNE (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JEANNE
Last Name:MEYERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8111 DODGE ST
Mailing Address - Street 2:STE 143
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4100
Mailing Address - Country:US
Mailing Address - Phone:402-354-5980
Mailing Address - Fax:405-354-5973
Practice Address - Street 1:8111 DODGE ST
Practice Address - Street 2:STE 143
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4100
Practice Address - Country:US
Practice Address - Phone:402-354-5980
Practice Address - Fax:405-354-5973
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18752207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4927178Medicaid
NE10025058900Medicaid
277144Medicare ID - Type Unspecified
IA4927178Medicaid