Provider Demographics
NPI:1205250602
Name:JEPSEN OPTOMETRY, PC
Entity type:Organization
Organization Name:JEPSEN OPTOMETRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MURIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JEPSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-290-1151
Mailing Address - Street 1:6304 N 99TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-1528
Mailing Address - Country:US
Mailing Address - Phone:402-492-9440
Mailing Address - Fax:
Practice Address - Street 1:6304 N 99TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-1528
Practice Address - Country:US
Practice Address - Phone:402-492-9440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026402600Medicaid
NE10026402600Medicaid