Provider Demographics
NPI:1770965659
Name:MIXAN, JANNA L (OD)
Entity type:Individual
Prefix:
First Name:JANNA
Middle Name:L
Last Name:MIXAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:805 W CENTENNIAL RD
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-7017
Mailing Address - Country:US
Mailing Address - Phone:531-233-5680
Mailing Address - Fax:531-215-0937
Practice Address - Street 1:12424 W DODGE RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2322
Practice Address - Country:US
Practice Address - Phone:531-233-5680
Practice Address - Fax:531-215-0937
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078273152W00000X
NE1455152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist