Provider Demographics
NPI:1184976425
Name:JEPSON, KARL THOMAS (OD)
Entity type:Individual
Prefix:MR
First Name:KARL
Middle Name:THOMAS
Last Name:JEPSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E PHILIP AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5538
Mailing Address - Country:US
Mailing Address - Phone:308-534-2441
Mailing Address - Fax:
Practice Address - Street 1:510 E PHILIP AVE
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5538
Practice Address - Country:US
Practice Address - Phone:308-534-2441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1442152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist